Does D4265 include the cost of biologic materials?

Yes, D4265 covers the application of biologic materials, but it does not include surgical entry or closure.

What types of biologic materials are used with D4265?

The types of biologic materials can vary, including growth factors and other regenerative substrates, depending on the defect's needs.

Is pre-authorization required for D4265?

Pre-authorization requirements vary by insurance provider, so it's important to verify with the patient's plan before proceeding.

How should D4265 be documented for insurance claims?

Ensure comprehensive documentation, including clinical notes, materials used, and the specific site of application, to support the claim.

D4265

Biologic Materials for Tissue Regeneration - CDT Code Guide

Periodontics/Surgical Services (Including Usual Postoperative Care)

Overview

CDT code D4265 refers to the use of biologic materials to aid in the regeneration of soft and osseous tissue, applied per site. This procedure is essential in periodontics, particularly when addressing periodontal defects that require enhanced healing and regeneration. Biologic materials may be used alone or in conjunction with other regenerative substrates such as bone grafts or barrier membranes, depending on the specific needs of the defect. It is important to note that D4265 does not include surgical entry, closure, or the placement of graft materials. Dental professionals often utilize this code when biologic materials are the primary component in the regenerative process.

When to Use This Code

When biologic materials are used to enhance healing in periodontal defects.
In cases where soft tissue regeneration is needed without surgical entry.
When biologic materials are applied per site for osseous tissue regeneration.
In conjunction with other regenerative procedures that do not include graft placement.
For periodontal defects that require biologic materials as the primary regenerative method.

Documentation Requirements

Detailed patient history and diagnosis supporting the need for tissue regeneration.
Clinical notes describing the periodontal defect and treatment plan.
Documentation of the biologic materials used and their application per site.
Photographic evidence or radiographs showing the defect and treatment area.
Post-procedure notes detailing patient response and follow-up care plans.

Billing Considerations

When billing for D4265, ensure that the procedure is not bundled with other surgical services that include graft placement or barrier membranes. Frequency limitations may apply based on the patient's insurance plan, and it's important to verify coverage for biologic materials. Common modifiers such as -51 (multiple procedures) may be applicable if performed in conjunction with other procedures. Always check with the patient's insurance provider for specific coverage details.

Related CDT Codes

D4260 D4263 D4264 D4266 D4267

Frequently Asked Questions

Yes, D4265 can be billed alongside other procedures, but ensure that each procedure is documented separately and justified.

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