23 MAC Pt. 204, R. 1.15
Bone Replacement Graft
Cite as 23 Miss. Admin. Code Pt. 204, R. 1.15
Bone Replacement Graft
A. The Division of Medicaid defines a bone replacement graft as a procedure which involves the
use of osseous autografts, osseous allografts, or non-osseous grafts to stimulate bone
formation or periodontal regeneration when the disease process has led to a deformity of the
bone. This procedure does not include flap entry and closure. The Division of Medicaid
defines the following as:
1. Osseous autograft as a graft taken from one part of the body and placed in another site on
the same individual.
2. Osseous allograft as a graft between two or more individuals allogenic at one or more
loci.
3. Non-osseous as a graft not composed of bone such as tendon or ligament tissue, and the
material can be artificial, synthetic or natural.
B. Providers must bill the appropriate dental procedure code when providing this service.