Coding: Browse HCPCS Level II 2020 Edition

Browse HCPCS Level II 2020 Edition

HCPCS Level II Table of Contents

D4210 - D4285 Periodontics - Surgical Services (Including Usual Postoperative Care)

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