Summary & Overview
CPT 15101: Split-Thickness Autograft, Each Additional 100 sq. cm. or Less
CPT 15101: Split-Thickness Autograft, Each Additional 100 sq. cm. or Less
CPT code 15101 is a critical billing code in dermatologic and plastic surgery, representing each additional 100 square centimeters or less of split-thickness autograft performed after the primary procedure. This code is most often used in inpatient hospital settings for patients requiring extensive skin grafting, such as those with severe burns or traumatic injuries. The procedure is a cornerstone in reconstructive surgery, enabling clinicians to restore skin integrity and function in complex cases.
Key national payers covering this code include Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare. The publication provides a comprehensive overview of payer coverage, clinical benchmarks, and policy updates relevant to CPT 15101. Readers will gain insights into reimbursement trends, coding practices, and the clinical context for split-thickness autograft procedures. The analysis also highlights common modifiers and associated taxonomies, offering a clear understanding of how this code fits within broader surgical billing and documentation frameworks.
This summary equips healthcare professionals, billing specialists, and policy analysts with essential information to navigate the complexities of medical billing for advanced skin graft procedures, ensuring accurate reporting and compliance across major payers.
CPT Code Overview
CPT 15101 is used to report each additional 100 square centimeters or less of split-thickness autograft procedures following the primary graft, such as those described by CPT 15100. This code is commonly utilized in dermatologic and plastic surgery settings, particularly for the treatment of extensive skin injuries like burns. The typical site of service for this procedure is the inpatient hospital setting, where patients require advanced surgical care for skin grafting. This code is essential for accurately documenting and billing for incremental grafting work beyond the initial procedure, ensuring comprehensive coverage of complex reconstructive cases.
Clinical & Coding Specifications
Clinical Context
A patient with extensive third-degree burns involving areas such as the head, face, neck, chest wall, right upper limb, right hand, or right lower limb is admitted to an inpatient hospital setting. After initial wound debridement and preparation, the surgical team performs a split-thickness skin autograft to cover the affected areas. The primary procedure involves grafting the first 100 sq. cm. (coded as 15100), and for each additional 100 sq. cm. or less, the procedure is coded as 15101. The workflow includes assessment, surgical planning, harvesting donor skin, graft placement, and post-operative care, typically managed by surgery or plastic surgery specialists.
Coding Specifications
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Modifier
51(Multiple Procedures):- Used when multiple procedures are performed during the same operative session. Indicates that
15101is an additional procedure after the primary autograft.
- Used when multiple procedures are performed during the same operative session. Indicates that
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Modifier
59(Distinct Procedural Service):- Used to identify procedures/services that are not normally reported together, but are appropriate under the circumstances. May be applied if
15101is performed at a different anatomical site or in a distinct session from the primary procedure.
- Used to identify procedures/services that are not normally reported together, but are appropriate under the circumstances. May be applied if
| Provider Taxonomy Code | Specialty Name |
|---|---|
208600000X | Surgery Physician |
208800000X | Plastic Surgery Physician |
2086S0122X | Surgical Critical Care Physician |
- Surgery Physician: General surgical procedures, including skin grafts.
- Plastic Surgery Physician: Specialized in reconstructive and skin graft procedures.
- Surgical Critical Care Physician: Manages critically ill surgical patients, including those with severe burns.
Related Diagnoses
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T20.30XA- Burn of third degree of head, face, and neck, unspecified site, initial encounter- Indicates severe burns requiring grafting in the head, face, or neck region.
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T21.31XA- Burn of third degree of chest wall, initial encounter- Represents third-degree burns of the chest wall, often necessitating skin graft procedures.
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T22.30XA- Burn of third degree of right upper limb, unspecified site, initial encounter- Applies to extensive burns on the right upper limb, relevant for autograft coverage.
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T23.301A- Burn of third degree of right hand, unspecified site, initial encounter- Used for third-degree burns of the right hand, a common site for grafting.
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T24.301A- Burn of third degree of right lower limb, unspecified site, initial encounter- Indicates third-degree burns of the right lower limb, requiring split-thickness autograft.
Related CPT Codes
15100- Split-thickness autograft, trunk, arms, legs; first 100 sq. cm or less
Clinical Relationship:
15100is the primary code for the first 100 sq. cm. of split-thickness autograft performed on the trunk, arms, or legs.15101is used for each additional 100 sq. cm. or less after the initial area covered by15100.- These codes are commonly used together in cases where the total graft area exceeds 100 sq. cm., with
15100billed first and15101for each subsequent increment.
National Reimbursement Benchmarks
Medicare's national mean rate for CPT code 15101 is $207.48, closely aligned with the BUCA (average commercial) mean rate of $206.77. Among commercial payers, UnitedHealth Group has the highest mean rate at $275.17, while Aetna is the lowest at $176.37.
Rate dispersion, measured by the difference between the 75th and 25th percentiles, varies significantly across payers. Medicare exhibits the tightest range ($22.00), indicating relatively consistent reimbursement rates. In contrast, UnitedHealth Group shows the widest range ($156.00), reflecting greater variability in commercial payments. Cigna and Blue Cross Blue Shield also display substantial dispersion, with ranges of $129.50 and $81.83, respectively.
The table and chart below present a detailed breakdown of national benchmarks for each payer, including mean rates and percentile values.
State Benchmarks
State: AK1 / 50
Alaska Benchmarks
Alaska exhibits a substantial spread in reimbursement rates for CPT code 15101 across payers. The rate spread, calculated as the difference between the 75th and 25th percentiles, is most pronounced for Blue Cross Blue Shield ($217.95) and Cigna ($250.50), indicating considerable variability in negotiated rates. Aetna's rates are tightly clustered, with all percentiles at $699.50, suggesting uniformity in provider reimbursement. UnitedHealth Group and BUCA also show moderate spreads, while Medicare's rates are relatively consistent.
Compared to national averages, Alaska's commercial payers reimburse at significantly higher levels. For example, Aetna's mean rate in Alaska is $624.00, far above the national mean of $176.37. This pattern holds for all major payers, with even Medicare's mean rate in Alaska ($200.93) closely matching the national average. The table and chart below present the full breakdown of payer-specific rates in Alaska.
Key Insights for Alaska
- Aetna is the highest paying payer in Alaska for CPT 15101, with a mean rate of $624.00, while Medicare is the lowest at $200.93.
- All commercial payers in Alaska reimburse at rates significantly above their respective national averages, with Aetna's mean rate nearly 3.5 times the national mean.
- The rate spread for Blue Cross Blue Shield and Cigna is notably wide, indicating substantial variation in reimbursement depending on provider contracts.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.