Summary & Overview
CPT 15113: Tissue Cultured Epidermal Autograft, Additional 100 sq cm
CPT code 15113 is a specialized billing code for the application of tissue cultured epidermal autografts to sensitive areas such as the face, scalp, ears, eyelids, nose, lips, or neck. This code is used for each additional 100 square centimeters, supplementing the primary autograft procedure. The use of tissue cultured epidermal autografts is significant in dermatology and plastic surgery, particularly for patients with extensive burns, scar conditions, or other complex skin injuries.
Blue Cross Blue Shield is the primary payer covered in this analysis. Readers will gain insight into the clinical context of this procedure, typical sites of service, and relevant benchmarks for outpatient hospital settings. The publication also covers policy updates, common billing modifiers, and associated provider taxonomies. Additionally, it provides an overview of related CPT codes and ICD-10 diagnoses commonly linked to this procedure, offering a comprehensive understanding of its role in modern skin grafting practices.
This summary is designed for healthcare professionals, billing specialists, and policy analysts seeking clarity on the use and reimbursement of CPT code 15113 within the broader landscape of dermatology and reconstructive surgery.
CPT Code Overview
CPT code 15113 describes the procedure for applying an autograft of tissue cultured epidermal skin to the face, scalp, ears, eyelids, nose, lips, or neck. This code is used for each additional 100 square centimeters, or part thereof, and is listed separately in addition to the code for the primary procedure. The service type is dermatology, and the typical site of service is an outpatient hospital setting (Place of Service 22). This procedure is commonly performed to address complex skin conditions requiring advanced grafting techniques.
Clinical & Coding Specifications
Clinical Context
A patient presents to the outpatient hospital with extensive scarring or burns involving the face, scalp, ears, eyelids, nose, lips, or neck. The clinical workflow involves assessment by a dermatology, plastic surgery, or family medicine physician. After determining the need for skin replacement, the provider performs a tissue cultured epidermal autograft. The primary procedure covers an initial area, and when the affected area exceeds 100 sq cm, the provider uses CPT code 15113 for each additional 100 sq cm or part thereof. This procedure is typically performed in cases of severe burns or significant scar conditions requiring large surface area coverage with cultured skin grafts.
Coding Specifications
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Modifier
51(Multiple Procedures): Used when more than one procedure is performed during the same session, indicating that15113is an additional procedure. -
Modifier
59(Distinct Procedural Service): Used to indicate that15113is a distinct service from other procedures performed on the same day.
| Provider Taxonomy Code | Specialty |
|---|---|
207ND0101X | Dermatology Physician |
208200000X | Plastic Surgery Physician |
207Q00000X | Family Medicine Physician |
Related Diagnoses
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L90.5: Scar conditions and fibrosis of skin- Relevant for patients requiring autografts due to scarring or fibrotic changes in the skin.
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T20.30XA: Burn of unspecified degree of head, face, and neck, initial encounter- Indicates acute burns in the head, face, and neck, often necessitating skin grafting procedures.
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T21.30XA: Burn of unspecified degree of trunk, initial encounter- Used when burns extend to the trunk, which may require similar grafting techniques.
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T22.30XA: Burn of unspecified degree of upper limb, initial encounter- Relevant for burns on the upper limb, potentially requiring autograft procedures.
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T23.301A: Burn of unspecified degree of right hand, initial encounter- Indicates burns on the right hand, which may be treated with tissue cultured epidermal autografts if extensive.
Related CPT Codes
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15110: Autograft, skin, tissue cultured epidermal autograft, face, scalp, ears, eyelids, nose, lips, or neck; first 25 sq cm or less.- Used for the initial 25 sq cm of autograft placement. Commonly billed as the primary procedure when the area is small.
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15111: Autograft, skin, tissue cultured epidermal autograft, face, scalp, ears, eyelids, nose, lips, or neck; each additional 25 sq cm, or part thereof.- Used for each additional 25 sq cm after the first 25 sq cm. Often used in conjunction with
15110for larger areas.
- Used for each additional 25 sq cm after the first 25 sq cm. Often used in conjunction with
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15220: Full thickness graft, free, including direct closure of donor site, face, scalp, ears, eyelids, nose, lips, or neck; 20 sq cm or less.- Alternative procedure for full thickness grafts in the same anatomical regions, typically used when autograft is not indicated.
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15240: Full thickness graft, free, including direct closure of donor site, face, scalp, ears, eyelids, nose, lips, or neck; 20 sq cm or less.- Similar to
15220, used for full thickness grafts in the same regions. May be used as an alternative or in combination depending on clinical needs.
- Similar to
National Reimbursement Benchmarks
For CPT code 15113, the national mean rate for Blue Cross Blue Shield and BUCA (average commercial) is $80.02. Medicare rates are not available in the input, so a direct comparison between commercial and Medicare reimbursement is not possible.
Rate dispersion for both Blue Cross Blue Shield and BUCA is minimal, with the 25th, 50th, and 75th percentiles all at $80.00. This indicates a very tight range, with no variation across these percentiles for these payers. No data is available for Aetna, Cigna, UnitedHealthcare, or Medicare.
The table and chart below present the full breakdown of national mean rates and percentile values for each payer.
State Benchmarks
State: AK1 / 46
Alaska Benchmarks
For CPT code 15113, Alaska's reimbursement rates from Blue Cross Blue Shield and BUCA are highly consistent, with all percentile values at $80.00 and a mean rate of $80.82. The rate spread (75th percentile minus 25th percentile) is $0.00, indicating no variation in payment amounts across providers for these payers. This uniformity is notable compared to other states where rate spreads can be more pronounced.
Alaska's mean rates for Blue Cross Blue Shield and BUCA are slightly above the national averages by $0.79. The table and chart below present the full payer breakdown for Alaska, highlighting the lack of variability and the alignment with national benchmarks.
Key Insights for Alaska
- Blue Cross Blue Shield and BUCA both reimburse at $80.82, representing the highest and lowest mean rates in Alaska for CPT 15113.
- There is no rate spread in Alaska; all percentiles are identical, indicating uniform reimbursement across payers.
- Alaska's mean rates are slightly higher than national averages by $0.79.
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