Summary & Overview
CPT 15114: Split-Thickness Autograft Application, Additional 100 sq cm
CPT code 15114 is a surgical billing code for the application of split-thickness autografts to the face, scalp, eyelids, mouth, neck, ears, orbits, covering each additional 100 sq cm or part thereof. This procedure is critical for patients with burns, wounds, or skin disorders affecting these sensitive areas, and is typically performed in outpatient hospital settings. The code is used in conjunction with primary autograft application codes to account for larger treatment areas.
Blue Cross Blue Shield is a key payer included in this analysis. The publication provides an overview of clinical indications, typical sites of service, and relevant coding practices. Readers will gain insight into national benchmarks, policy updates, and clinical context for the use of 15114, including its relationship to primary and related CPT codes. The summary also covers common modifiers and associated taxonomies, offering a comprehensive view of how this code is utilized in surgical and dermatological practice. This information is essential for understanding reimbursement, compliance, and coding accuracy for split-thickness autograft procedures.
CPT Code Overview
CPT code 15114 describes the application of a split-thickness autograft to the face, scalp, eyelids, mouth, neck, ears, orbits for areas of 100 sq cm or less, specifically for each additional 100 sq cm or part thereof. This procedure is classified under surgery and is commonly performed in an outpatient hospital setting (Place of Service 22). Split-thickness autografts are used to treat complex wounds, burns, and other conditions requiring skin replacement, providing essential coverage and promoting healing in sensitive anatomical regions.
Clinical & Coding Specifications
Clinical Context
A patient presents to the outpatient hospital with a third-degree burn or significant scar tissue involving the face, scalp, eyelids, mouth, neck, ears, or orbits. After initial wound management and surgical preparation of the recipient site, the provider applies a split-thickness autograft to cover an area greater than 100 sq cm. The procedure is performed by a specialist in plastic surgery, dermatology, or general surgery. The workflow includes assessment, excision of nonviable tissue, preparation of the recipient site, harvesting of the autograft, and application to the affected area. Additional increments of 100 sq cm or part thereof are coded separately using 15114 in addition to the primary procedure code.
Coding Specifications
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Modifier
51(Multiple Procedures):- Used when more than one surgical procedure is performed during the same session by the same provider.
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Modifier
59(Distinct Procedural Service):- Used to indicate that a procedure or service is distinct or independent from other services performed on the same day.
| Taxonomy Code | Specialty |
|---|---|
208200000X | Plastic Surgery |
207N00000X | Dermatology |
208600000X | Surgery |
- These taxonomies represent providers specializing in plastic surgery, dermatology, and general surgery, all of whom may perform split-thickness autograft procedures.
Related Diagnoses
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T20.30XA- Burn of third degree of head, face, and neck, initial encounter- Indicates a severe burn requiring grafting in the specified regions.
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L90.5- Scar conditions and fibrosis of skin- Represents chronic scarring or fibrosis, often necessitating surgical intervention with grafting.
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T21.31XA- Burn of third degree of chest wall, initial encounter- While not directly related to the face or neck, may be relevant if multiple areas require grafting.
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S01.90XA- Unspecified open wound of head, initial encounter- Open wounds in the head region may require autograft application for closure and healing.
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L98.9- Disorder of the skin and subcutaneous tissue, unspecified- Used for unspecified skin disorders that may necessitate grafting procedures.
Related CPT Codes
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15110- Application of split-thickness autograft, face, scalp, eyelids, mouth, neck, ears, orbits, 100 sq cm or less- Used for the initial 100 sq cm or less;
15114is used for each additional 100 sq cm or part thereof.
- Used for the initial 100 sq cm or less;
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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 autograft application to prepare the recipient site.
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15220- Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less- Alternative procedure for smaller areas or when full-thickness graft is clinically indicated.
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15240- Full thickness graft, free, including direct closure of donor site, face, scalp, eyelids, mouth, neck, ears, orbits; 20 sq cm or less- Used for full-thickness grafts in the same anatomical regions as
15114, but for smaller areas.
- Used for full-thickness grafts in the same anatomical regions as
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15110and15114are commonly used together when the grafted area exceeds 100 sq cm.15002is typically performed prior to graft application.15220and15240are alternatives when full-thickness grafts are required instead of split-thickness.
National Reimbursement Benchmarks
Blue Cross Blue Shield and BUCA (average commercial) both report a national mean rate of $80.02 for CPT code 15114. Medicare data is not available in the input, so a comparison between commercial and Medicare rates cannot be made.
Rate dispersion is minimal across both commercial payers, with the 25th, 50th, and 75th percentiles all at $80.00. This indicates a very tight range, with no significant variation in reimbursement rates nationally for this code. The table and chart below present the full breakdown of national benchmarks by payer.
State Benchmarks
State: AK1 / 46
Alaska Benchmarks
For CPT code 15114, reimbursement rates in Alaska are highly consistent across Blue Cross Blue Shield and BUCA, with all percentile values—25th, 50th, and 75th—equal to $80.00. This results in a rate spread of $0.00, indicating no variation in payment amounts among these payers. Such uniformity is uncommon and suggests standardized pricing for this procedure in the state.
Compared to national averages, Alaska's mean rates are slightly higher, with both Blue Cross Blue Shield and BUCA averaging $80.82 versus the national mean of $80.02. The table and chart below present the full payer breakdown for Alaska, highlighting the lack of rate variation and the state's position relative to national benchmarks.
Key Insights for Alaska
- Blue Cross Blue Shield and BUCA both reimburse at $80.82, representing the highest and lowest rates in Alaska for CPT 15114.
- 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 for CPT 15114.
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