Summary & Overview
CPT 15104: Split-Thickness Autograft for Trunk, Arms, Legs
Headline: CPT 15104: Split-Thickness Autograft for Trunk, Arms, and Legs
Lead: CPT 15104 denotes a split-thickness autograft covering the first 100 square centimeters (or 1% of body area for infants and children) on the trunk, arms, or legs. The code is an important surgical billing descriptor for inpatient skin graft procedures used in wound and burn management.
What this code represents and national relevance
CPT 15104 captures a common reconstructive and wound-coverage technique that uses the patient’s own partial-thickness skin to close defects. Nationally, accurate reporting of this code matters for clinical documentation, resource planning in inpatient surgical services, and consistent communication between surgical teams and payers.
Key payers covered This publication covers major commercial and public payers: Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare.
What readers will learn Readers will find a concise overview of the clinical context for split-thickness autografts, coding specifics for the initial graft area, typical inpatient site-of-service considerations, commonly applied modifiers, and related procedural codes used in graft and wound preparation workflows. The piece highlights coding adjacency with services such as recipient site preparation and additional graft sizing codes, and notes typical presenting diagnoses associated with grafting (burns, pressure ulcers, open wounds). Benchmarks, coding practice considerations, and policy notes relevant to hospital billing and payer adjudication are summarized for national audiences.
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CPT Code Overview
CPT 15104 describes a split-thickness autograft performed on the trunk, arms, or legs and reports the first 100 square centimeters or less, or 1% of body area for infants and children. This is a surgical procedure typically used to cover wounds, burns, or areas requiring skin replacement using the patient’s own tissue.
Service type: Surgery
Typical site of service: Inpatient Hospital (POS 21)
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult admitted to the inpatient hospital for treatment of full- or partial-thickness skin loss from burns or traumatic/pressure wounds. The patient has wound bed preparation completed (debridement and hemostasis) and requires a split-thickness autograft from a donor site on the trunk, arm, or leg. The operative workflow includes preoperative assessment, harvesting a split-thickness skin graft (first 100 sq cm or less) from an appropriate donor site, placement and fixation of the graft on the recipient site, and postoperative dressing and inpatient monitoring for graft take, infection, and donor-site healing. The service is performed in the operating room with involvement of a surgery or plastic surgery physician and, when necessary, surgical critical care for medically complex patients.
Coding Specifications
-
Modifier
51(Multiple Procedures): Use when multiple distinct surgical procedures are performed on the same day by the same provider and the payer requires identification of secondary procedures for appropriate payment adjustments. -
Modifier
59(Distinct Procedural Service): Use when the split-thickness autograft represents a procedure not normally reported together with another procedure, or when a separate session, site, or distinct procedure service is documented and meets payer criteria for distinctness.
Provider Taxonomies
| Taxonomy Code | Specialty |
|---|---|
208600000X | Surgery Physician |
208800000X | Plastic Surgery Physician |
2086S0122X | Surgical Critical Care Physician |
Related Diagnoses
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T20.30XA— Burn of third degree of head, face, and neck, unspecified site, initial encounterClinical relevance: Third-degree burns create full-thickness skin loss that often requires skin grafting such as a split-thickness autograft when donor and recipient site anatomy and clinical status indicate.
-
T24.301A— Burn of unspecified degree of right lower leg, initial encounterClinical relevance: Lower-extremity burns may necessitate wound excision and coverage with a split-thickness autograft on the trunk, arm, or leg donor sites described by
15104. -
T31.0— Burns involving less than 10% of body surfaceClinical relevance: Extent of burns guides operative planning and graft sizing; small total body surface area burns may still require grafting using the area limits defined in
15104. -
L89.309— Pressure ulcer of unspecified site, stage 3Clinical relevance: Stage 3 pressure ulcers with full-thickness tissue loss can require excision and coverage with split-thickness autografts when local wound management and reconstruction are indicated.
-
S81.009A— Unspecified open wound, unspecified knee, initial encounterClinical relevance: Open wounds of the knee may require graft coverage after debridement; grafts harvested and described by
15104may be used to cover such defects depending on size and location.
Related CPT Codes
| CPT Code | Description | Relationship to 15104 |
|---|---|---|
15002 | Surgical preparation or creation of recipient site by excision of open wounds, burn eschar, or scar | Performed prior to grafting to prepare recipient bed; commonly done on the same operative date when excision of eschar or scar is needed before application of 15104. Often billed together when documentation supports both services. |
15100 | Split-thickness autograft, face, scalp, ears, neck, orbits, genitalia, hands, feet; first 100 sq cm or less | Alternative anatomical grouping for grafts on specialized sites (face, hands, feet) rather than trunk/arms/legs. Used instead of 15104 when the graft site fits the listed anatomic regions. |
15120 | Split-thickness autograft, face, scalp, ears, neck, orbits, genitalia, hands, feet; each additional 100 sq cm | Used in conjunction with the first-unit graft code for additional graft area when the first 100 sq cm is exceeded; relates to 15104 when larger total graft area is required and the anatomic site coding rules allow combining. |
15200 | Full-thickness graft, free, including direct closure of donor site, face, scalp, ears, neck, orbits, genitalia, hands, feet; 20 sq cm or less | Alternative graft technique (full-thickness) for specific indications or anatomic sites. Selected instead of 15104 when a full-thickness graft is clinically indicated for the listed regions. |
National Reimbursement Benchmarks
Blue Cross Blue Shield national mean rate for CPT 15104 aligns with BUCA (average commercial), both at $80.02. Medicare figures are not provided in the input, so direct comparison to Medicare is not available.
Rate dispersion among the reported payers is very tight for BCBS and BUCA: the 75th percentile and 25th percentile are both $80.00, yielding a range of $0.00. Other major payers (Aetna, Cigna, UnitedHealth Group, Medicare) are not present in the provided data. The table and chart below present the full breakdown of available national benchmarks.
State Benchmarks
State: AK1 / 46
Alaska Benchmarks
For CPT 15104, Alaska's reimbursement rates from Blue Cross Blue Shield and BUCA are highly consistent, with no spread between the 25th and 75th percentiles; all values are $80.00. This indicates a uniform payment structure for this code across these payers in the state. The mean rate in Alaska is $80.82, which is slightly above the national mean of $80.02, but the difference is marginal.
The table and chart below present the full payer breakdown for Alaska, showing the mean rates and percentile values for each payer with available data.
Key Insights for Alaska
- Blue Cross Blue Shield and BUCA both reimburse at the same mean rate of $80.82 for CPT
15104, making them the highest and lowest paying payers in Alaska. - There is no rate spread between the 25th and 75th percentiles; all values are $80.00, indicating uniform reimbursement across payers.
- Alaska's mean rates are slightly higher than national averages, but the difference is minimal.
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