D4263Bone Replacement Graft - Retained Natural Tooth - First Site in Quadrant

What This Code Covers

D4263 covers the placement of bone replacement graft material into a periodontal bone defect around a retained natural tooth. The graft material (autogenous bone, allograft, xenograft, or alloplast) is placed into the defect to promote bone regeneration and fill the osseous crater caused by periodontal disease. This code covers the first graft site in a quadrant and is typically billed in conjunction with osseous surgery (D4260/D4261).

Billing Guide

Bill this code when:

• Bone graft material is placed into a periodontal defect around a natural tooth
• This is the first graft site in the quadrant
• The graft is performed during periodontal surgery (flap procedure)
• The goal is to regenerate bone lost to periodontal disease

Do not bill this code when:

• The graft is around an implant, not a natural tooth. Use D6104
• This is an additional (second or subsequent) graft site in the same quadrant. Use D4265
• The graft is placed in an extraction socket. Use D7953
• Guided tissue regeneration membrane is placed. Bill D4266 separately

Insurance and Denial Prevention

Key Payer Rules:

• D4263 is typically billed in addition to the osseous surgery code (D4260/D4261)
• Coverage for bone grafts varies widely by payer
• Some plans exclude periodontal bone grafts entirely
• The graft material cost is included in D4263 (not billed separately)
• Documentation of the defect type and dimensions strengthens the claim

Common Denials and How to Respond:

• Not a covered benefit - Some plans exclude bone grafts. Verify benefits before treatment. If denied, appeal with literature supporting bone grafts for the specific defect type.
• Bundled with osseous surgery - D4263 is a separate procedure from D4260/D4261. Appeal with documentation showing the graft material placement was an additional regenerative procedure.
• Not medically necessary - Submit radiographs showing the bone defect and clinical notes describing the defect morphology (three-wall defects have the best prognosis for grafting).