D4264Bone Replacement Graft - Retained Natural Tooth - Each Additional Site in Quadrant

What This Code Covers

D4264 covers bone replacement graft - retained natural tooth - each additional site in quadrant. Graft material is placed to regenerate bone lost due to periodontal disease. Documentation should include the defect location, graft material type, and barrier membrane use if applicable.

Billing Guide

Bill this code when:

• The graft procedure described by D4264 is performed
• The graft material type and site match the code description
• Documentation includes the defect size, graft material, and surgical technique

Do not bill this code when:

• The graft type or material does not match this code
• The graft is included in another surgical code being billed at the same visit
• No actual graft material was placed
• The procedure is better described by D4245 (Apically positioned flap)

Insurance and Denial Prevention

Key Payer Rules:

• Periodontal treatment is typically covered as a major service (50-80%)
• Full-mouth debridement (D4355) and D4346 may have specific frequency limits
• Surgical periodontal procedures often require documentation of previous non-surgical treatment
• Some plans require periodontal charting with probing depths for approval

Common Denials and How to Respond:

• Insufficient documentation - Submit complete periodontal charting, radiographs, and a narrative of findings.
• Non-surgical treatment not attempted first - Document previous scaling/root planing and explain why surgery is now indicated.
• Frequency exceeded - Verify the payer's frequency schedule for the specific procedure.