CPT 14021Surgery

Tis trnfr s/a/l 10.1-30 sqcm

CPT 14021 covers the surgical transfer of skin and underlying tissue (a flap) to repair wounds on the scalp, arms, or legs when the defect measures between 10.1 and 30 square centimeters. This is a more complex repair than simple stitches, involving moving healthy tissue from nearby areas to cover the wound.

Showing rates for

National Average

Base Medicare rate

$851.04

This calculator gives a typical-case estimate using standard Medicare modifier rules. Actual payment depends on payer policies, documentation, code-specific CMS status indicators, and locality. Verify before billing.

RVU breakdown

Work RVU

9.72

PE RVU (NF)

15.22

MP RVU

1.37

Total RVU

26.31

Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High

NCCI bundling edits

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Billing tips

Document precise defect measurements in square centimeters in the operative report, measured after excision and before tissue transfer begins
Impact: Prevents downcoding to 14020 (10 sq cm or less, pays $568.12) resulting in $282.92 underpayment, or upcoding denials if documentation shows <10.1 sq cm
Bill the excision code (e.g., 11606) separately from 14021 with modifier 59 when both are performed, as tissue transfer is not bundled with malignant lesion excision
Impact: Captures additional $300-$600 in reimbursement for the excision component that would otherwise be lost if only billing the repair
Verify anatomic site is scalp, arms, or legs; use different code series (14040-14041) for forehead/cheeks/chin/mouth/neck/axillae/genitalia/hands/feet
Impact: Using incorrect anatomic code family results in automatic denial and rebilling delays of 30-60 days; 14040 for other sites pays $1,020.78, a $169.74 difference
Include documentation of undermining extent, tissue advancement/rotation distance, and closure of both primary defect and secondary defect/donor site
Impact: Prevents downcoding to intermediate repair codes (12031-12037, paying $150-$400) representing $450-$700 loss per procedure
Use time-based or defect-based documentation to justify complexity when approaching size thresholds, and photograph defect with measurement tool visible
Impact: Photographic evidence reduces audit vulnerability by 60-70% and supports medical necessity, protecting the full $851.04 reimbursement from post-payment recoupment
For facility billing, verify proper place of service code (22 for outpatient hospital, 24 for ASC) as this determines whether $851.04 or $694.80 rate applies

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Frequently asked questions

What is the Medicare reimbursement for CPT code 14021 in 2025?

The 2025 Medicare national average reimbursement for CPT 14021 is $851.04 for non-facility settings and $694.80 for facility settings. The total RVU is 26.31 with a work RVU of 9.72, using the 2025 conversion factor of 32.3465.

What is the difference between CPT 14021 and 14020?

CPT 14020 is for defects 10.0 sq cm or less on the same anatomic areas (scalp, arms, legs), while 14021 covers defects from 10.1 to 30.0 sq cm. The size difference results in a payment difference of $282.92 ($851.04 for 14021 vs $568.12 for 14020), making precise measurement documentation critical.

Can I bill CPT 14021 with an excision code on the same day?

Yes, CPT 14021 can be billed separately from excision codes (such as 11606 for malignant lesion excision) when both procedures are performed. Use modifier 59 on the tissue transfer code to indicate a distinct procedural service. Documentation must clearly separate the excision and reconstruction portions of the procedure.

What anatomic sites are covered by CPT 14021?

CPT 14021 specifically covers tissue transfers on the scalp, arms (upper and lower), and legs (upper and lower including thigh and calf). For tissue transfers on the forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, or feet, use CPT codes 14040-14041 instead, which have different reimbursement rates.

How do I measure the defect size for CPT 14021?

Measure the defect size in square centimeters after excision but before beginning the tissue transfer. Multiply the longest diameter by the shortest diameter for the area. The measurement must be between 10.1 and 30.0 sq cm. Document measurements in the operative report and consider intraoperative photos with a measurement ruler for audit protection.

What modifiers are commonly used with CPT 14021?

Common modifiers include 51 (multiple procedures), 59 (distinct procedural service when billing with excision), RT/LT (laterality), 58 (staged procedure during global period), 78 (return to OR for complication), and 22 (increased procedural complexity). Modifier choice depends on the specific clinical scenario and affects reimbursement significantly.

Does CPT 14021 include closure of the donor site?

Yes, CPT 14021 includes closure of both the primary defect and the secondary defect (donor site) created by the tissue transfer. You cannot separately bill for closing the donor site. The code encompasses all undermining, tissue mobilization, advancement or rotation, and both primary and secondary closures as part of the single procedure.