D4273Autogenous Connective Tissue Graft Procedure (Including Donor and Recipient Surgical Sites) First Tooth, Implant, or Edentulous Tooth Position in Graft

What This Code Covers

D4273 covers an autogenous connective tissue graft procedure for the first tooth, implant, or edentulous site. The provider harvests a piece of connective tissue from a donor site (typically the palate), then transplants it to the recipient site where gum tissue is needed. This is the most commonly performed gum grafting technique for root coverage and soft tissue augmentation. The code includes both the donor and recipient surgical sites.

Billing Guide

Bill this code when:

• A connective tissue graft is harvested from the patient's own tissue (autogenous)
• The graft is placed at the first recipient site to cover recession or augment tissue
• The procedure includes both the donor site surgery and the recipient site surgery
• The graft is for a natural tooth, implant, or edentulous area

Do not bill this code when:

• An additional (second or more) tooth or site is grafted in the same surgery. Use D4274 for each additional site
• A free gingival graft (surface tissue, not connective tissue) is used. Different technique
• Allograft tissue (from a tissue bank) is used instead of the patient's own tissue. Use D4275
• A pedicle graft with adjacent tissue is performed. Use D4270

Insurance and Denial Prevention

Key Payer Rules:

• D4273 includes both donor and recipient site surgery for the first site
• Each additional contiguous site is billed with D4274
• Most payers require functional necessity documentation (not esthetic alone)
• Some plans limit the number of graft sites per year or require pre-authorization
• The code applies to natural teeth, implants, and edentulous areas

Common Denials and How to Respond:

• Cosmetic procedure - Document the functional indication: progressive recession threatening the tooth, root sensitivity, history of root caries, or inadequate keratinized tissue for oral hygiene maintenance.
• Pre-authorization required - Submit a pre-treatment estimate with clinical documentation and photographs before performing the procedure.
• Not medically necessary - Submit recession measurements, photographs, and clinical notes showing the progression of recession or functional impairment.