Summary & Overview
CPT 15112: Skin Allograft Application, Additional 100 sq cm
CPT code 15112 is a surgical billing code for the application of an allograft, skin, or dermal substitute to the trunk, arms, or legs, covering each additional 100 square centimeters beyond the primary procedure. This code is significant in the national healthcare landscape as it supports advanced wound care for patients with burns, ulcers, and complex open wounds, often performed in outpatient hospital settings. The code is commonly used by surgical, plastic surgery, and surgical oncology physicians, reflecting its importance in multidisciplinary care.
Blue Cross Blue Shield is a key payer covered in this analysis, providing insight into reimbursement and policy considerations for this procedure. Readers will gain an understanding of clinical indications, relevant modifiers such as 59 for distinct procedural service and 51 for multiple procedures, and associated taxonomies. The publication also highlights related CPT codes and ICD-10 diagnoses, offering a comprehensive overview of coding practices and clinical context for skin allograft procedures. Benchmarks and policy updates are included to inform stakeholders about current trends and requirements in medical billing for advanced wound management.
CPT Code Overview
CPT code 15112 describes the application of an allograft, skin, or dermal substitute to the trunk, arms, or legs for each additional 100 square centimeters, or part thereof. This code is used in addition to the primary procedure and is typically performed as part of surgical interventions to treat complex wounds, burns, or ulcers. The service type is surgery, and the most common site of service is the outpatient hospital setting (Place of Service 22). This procedure is essential for patients requiring advanced wound care and reconstruction, supporting improved healing and recovery outcomes.
Clinical & Coding Specifications
Clinical Context
A patient presents to the outpatient hospital with a large wound on the trunk or lower extremity, such as a burn, chronic ulcer, or open wound. After surgical preparation of the recipient site, the provider applies a skin allograft or dermal substitute to cover the wound. The initial 100 sq cm is coded separately, and for each additional 100 sq cm or part thereof, CPT code 15112 is reported. This scenario is common in cases of extensive burns, pressure ulcers, or chronic wounds requiring staged grafting procedures.
Coding Specifications
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Modifier
59: Used to indicate a distinct procedural service, such as when the allograft is applied to a separate anatomical site or in a different session from other procedures. -
Modifier
51: Used to denote multiple procedures performed during the same operative session, such as when several grafts or related surgical services are provided.
| Provider Taxonomy Code | Specialty Name |
|---|---|
208600000X | Surgery Physician |
208800000X | Plastic Surgery Physician |
207XS0117X | Surgical Oncology Physician |
Related Diagnoses
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T20.30XA: Burn of unspecified degree of head, face, and neck, initial encounter- Relevant for patients with burns requiring grafting, though the anatomical site is not the trunk, arms, or legs.
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T24.301A: Burn of unspecified degree of right lower leg, initial encounter- Directly relevant for allograft application to the lower extremity.
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L89.309: Pressure ulcer of unspecified buttock, stage 3- Indicates a deep pressure ulcer that may require surgical grafting for wound closure.
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S81.009A: Unspecified open wound, unspecified knee, initial encounter- Represents an acute open wound that may necessitate grafting.
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L97.909: Non-pressure chronic ulcer of unspecified lower leg with unspecified severity- Chronic ulcers often require skin grafts or dermal substitutes for healing.
Related CPT Codes
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15110: Allograft, skin, dermal substitute, trunk, arms, legs; first 100 sq cm or less- Used for the initial 100 sq cm of allograft application.
15112is reported for each additional 100 sq cm.
- Used for the initial 100 sq cm of allograft application.
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15271: Application of skin substitute graft to trunk, arms, legs, total wound surface area up to 100 sq cm- Alternative code for skin substitute grafts, typically used for different types of graft materials or clinical scenarios.
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15002: Surgical preparation or creation of recipient site by excision of open wounds, burn eschar, or scar- Often performed prior to graft application to prepare the wound bed.
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15004: Surgical preparation or creation of recipient site by excision of open wounds, burn eschar, or scar, face, scalp, ears, neck, hands, feet, genitalia- Similar to
15002, but for different anatomical sites.
- Similar to
These codes are commonly used together in a clinical workflow: 15002 or 15004 for site preparation, followed by 15110 for the initial graft and 15112 for additional graft area. 15271 may be used as an alternative depending on the graft material and clinical indication.
National Reimbursement Benchmarks
For CPT code 15112, the national mean rate for Blue Cross Blue Shield and BUCA (average commercial) is $80.02. Medicare rates are not available in the input for comparison. Both commercial payers show identical mean rates, indicating uniformity in reimbursement levels across these segments.
Rate dispersion is minimal for both Blue Cross Blue Shield and BUCA, with the 25th, 50th, and 75th percentiles all at $80.00. This suggests a very tight distribution, with no variation between the lower and upper quartiles. The table and chart below present the full breakdown of national benchmarks for each payer.
State Benchmarks
State: AK1 / 46
Alaska Benchmarks
For CPT code 15112, reimbursement rates in Alaska are highly consistent across Blue Cross Blue Shield and BUCA, with no spread between the 25th and 75th percentiles. This means all providers receive nearly identical payments, and the rate spread (P75 minus P25) is $0.00. The mean rate in Alaska is $80.82, which is slightly above the national mean of $80.02.
The table and chart below present the full payer breakdown for Alaska, showing that both Blue Cross Blue Shield and BUCA pay at the same rate for this procedure. No other payers have available data for Alaska in this analysis.
Key Insights for Alaska
- Blue Cross Blue Shield and BUCA both offer the highest and lowest mean rates for CPT 15112 in Alaska, at $80.82.
- There is no rate spread between the 25th and 75th percentiles; all values are $80.00, indicating uniform reimbursement.
- Alaska's mean rates are slightly higher than national averages for CPT 15112.
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