|
D4210 |
 |
Gingivectomy or gingivoplasty - four or more contiguous teeth or tooth bounded spaces per quadrant
| short | Gingivectomy/plasty 4 or mor |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
|
|
|
D4211 |
|
Gingivectomy or gingivoplasty - one to three contiguous teeth or tooth bounded spaces per quadrant
| short | Gingivectomy/plasty 1 to 3 |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
|
|
|
D4212 |
|
Gingivectomy or gingivoplasty to allow access for restorative procedure, per tooth
| short | Gingivectomy/plasty rest |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
|
|
|
D4230 |
|
Anatomical crown exposure - four or more contiguous teeth or tooth bounded spaces per quadrant
| short | Ana crown exp 4 or> per quad |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
|
|
|
D4231 |
|
Anatomical crown exposure - one to three teeth or tooth bounded spaces per quadrant
| short | Ana crown exp 1-3 per quad |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
|
|
|
D4240 |
|
Gingival flap procedure, including root planing - four or more contiguous teeth or tooth bounded spaces per quadrant
| short | Gingival flap proc w/ planin |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
|
|
|
D4241 |
|
Gingival flap procedure, including root planing - one to three contiguous teeth or tooth bounded spaces per quadrant
| short | Gngvl flap w rootplan 1-3 th |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
|
|
|
D4245 |
|
Apically positioned flap
| short | Apically positioned flap |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
|
|
|
D4249 |
|
Clinical crown lengthening-hard tissue
| short | Crown lengthen hard tissue |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
|
|
|
D4260 |
|
Osseous surgery (including elevation of a full thickness flap entry and closure) - four or more contiguous teeth or tooth bounded spaces per quadrant
| short | Osseous surgery 4 or more |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | YYY |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 4.0 | 2 Date of Service Edit: Policy | Code Descriptor / CPT Instruction | | OPH | 4.0 | 2 Date of Service Edit: Policy | Code Descriptor / CPT Instruction |
|
|
|
|
D4261 |
|
Osseous surgery (including elevation of a full thickness flap entry and closure) - one to three contiguous teeth or tooth bounded spaces per quadrant
| short | Osseous surg 1 to 3 teeth |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
|
|
|
D4263 |
|
Bone replacement graft - retained natural tooth - first site in quadrant
| short | Bone replce graft first site |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | YYY |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 4.0 | 2 Date of Service Edit: Policy | Code Descriptor / CPT Instruction | | OPH | 4.0 | 2 Date of Service Edit: Policy | Code Descriptor / CPT Instruction |
|
|
|
|
D4264 |
|
Bone replacement graft - retained natural tooth - each additional site in quadrant
| short | Bone replce graft each add |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | YYY |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 3.0 | 3 Date of Service Edit: Clinical | Clinical: CMS Workgroup | | OPH | 3.0 | 3 Date of Service Edit: Clinical | Clinical: CMS Workgroup |
|
|
|
|
D4265 |
|
Biologic materials to aid in soft and osseous tissue regeneration
| short | Bio mtrls to aid soft/os reg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
|
|
|
D4266 |
|
Guided tissue regeneration - resorbable barrier, per site
| short | Guided tiss regen resorble |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
|
|
|
D4267 |
|
Guided tissue regeneration - nonresorbable barrier, per site (includes membrane removal)
| short | Guided tiss regen nonresorb |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
|
|
|
D4268 |
|
Surgical revision procedure, per tooth
| short | Surgical revision procedure |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
|
|
|
D4270 |
|
Pedicle soft tissue graft procedure
| short | Pedicle soft tissue graft pr |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | YYY |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 4.0 | 3 Date of Service Edit: Clinical | Clinical: CMS Workgroup | | OPH | 4.0 | 3 Date of Service Edit: Clinical | Clinical: CMS Workgroup |
|
|
|
|
D4273 |
|
Autogenous connective tissue graft procedure (including donor and recipient surgical sites) first tooth, implant, or edentulous tooth position in graft
| short | Auto tissue graft 1st tooth |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | YYY |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 1.0 | 2 Date of Service Edit: Policy | Code Descriptor / CPT Instruction | | OPH | 1.0 | 2 Date of Service Edit: Policy | Code Descriptor / CPT Instruction |
|
|
|
|
D4274 |
|
Mesial/distal wedge procedure, single tooth (when not performed in conjunction with surgical procedures in the same anatomical area)
| short | Mesial/distal wedge proc |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
|
|
|
D4275 |
|
Non-autogenous connective tissue graft (including recipient site and donor material) first tooth, implant, or edentulous tooth position in graft
| short | Non-auto graft 1st tooth |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
|
|
|
D4276 |
|
Combined connective tissue and double pedicle graft, per tooth
| short | Con tissue w dble ped graft |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
|
|
|
D4277 |
|
Free soft tissue graft procedure (including recipient and donor surgical sites), first tooth, implant or edentulous tooth position in graft
| short | Soft tissue graft firsttooth |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 1.0 | 2 Date of Service Edit: Policy | Code Descriptor / CPT Instruction | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
D4278 |
|
Free soft tissue graft procedure (including recipient and donor surgical sites), each additional contiguous tooth, implant or edentulous tooth position in same graft site
| short | Soft tissue graft addl tooth |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 3.0 | 3 Date of Service Edit: Clinical | Code Descriptor / CPT Instruction | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
D4283 |
|
Autogenous connective tissue graft procedure (including donor and recipient surgical sites) - each additional contiguous tooth, implant or edentulous tooth position in same graft site
| short | Auto tissue graft addl tooth |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
|
|
|
D4285 |
|
Non-autogenous connective tissue graft procedure (including recipient surgical site and donor material) - each additional contiguous tooth, implant or edentulous tooth position in same graft site
| short | Non-auto graft addl tooth |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
|
|