CPT 14301Surgery

Tis trnfr any 30.1-60 sq cm

CPT 14301 covers advanced skin reconstruction procedures where healthy tissue is moved from one area of the body to repair a defect measuring between 30.1 and 60 square centimeters (roughly the size of a large lemon). This is more complex than simple skin grafts because the tissue remains partially connected to its original blood supply during transfer.

Showing rates for

National Average

Base Medicare rate

$1,056.11

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

12.65

PE RVU (NF)

17.94

MP RVU

2.06

Total RVU

32.65

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

NCCI bundling edits

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Billing tips

Measure and document the final defect size after excision but before reconstruction begins; measure length times width at greatest dimensions in centimeters
Impact: Defect size determines code selection; undermeasurement could result in $300-500 underpayment if downcoded to 14040 (20-30 sq cm). Always document measurement methodology in operative note.
Do not separately bill for undermining, adjacent tissue rearrangement preparation, or simple layered closure - these are included in 14301
Impact: Prevents unbundling denials that trigger 100% claim rejection and potential audit flags. Undermining beyond defect margins is inherent to flap procedures.
Bill excision code separately with modifier 59 when lesion removal and tissue transfer are performed; document medical necessity for complex closure versus simple repair
Impact: Captures additional $150-800 depending on excision size and complexity. Many payers bundle without proper modifier use, resulting in significant lost revenue.
When performing tissue transfer in facility setting versus office, verify site of service differential of $206.01; ensure place of service code matches actual location
Impact: Incorrect POS code triggers auto-adjudication to wrong fee schedule; facility rate is $849.10 versus $1056.11 non-facility - $206.01 difference per claim
Photograph defect with measurement ruler before and after reconstruction; retain in medical record for audit defense
Impact: Visual documentation significantly increases successful appeal rate for denied claims, reducing write-offs. Particularly valuable for modifier 22 claims seeking additional payment.

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Frequently asked questions

What is the Medicare reimbursement rate for CPT code 14301 in 2025?

The 2025 Medicare national average reimbursement for CPT 14301 is $1,056.11 for non-facility settings and $849.10 for facility settings. These rates are based on a total RVU of 32.65 and the 2025 conversion factor of 32.3465. Actual reimbursement may vary based on geographic location and payer-specific fee schedules.

How do you measure defect size for CPT code 14301?

Measure the defect size after excision is complete but before tissue transfer begins. Multiply the longest dimension (length) by the widest perpendicular dimension (width) in centimeters to calculate square centimeters. For 14301, the defect must measure between 30.1 and 60 square centimeters. Document the measurement methodology clearly in the operative report.

Can I bill an excision code with CPT 14301?

Yes, when a lesion excision and tissue transfer are performed together, both codes may be billed separately. Report the excision code (11400-11646 series or other appropriate excision code) with modifier 59 to indicate it is a distinct procedure. Documentation must clearly support medical necessity for tissue transfer over simple closure of the excision site.

What is the difference between CPT 14301 and simple repair codes?

CPT 14301 describes adjacent tissue transfer (local flaps) involving tissue rearrangement with rotation, advancement, or transposition techniques. Simple repair codes (12xxx series) cover layered closure without significant tissue rearrangement or mobilization. The key distinction is whether tissue must be moved from adjacent areas to close the defect, not just approximated in layers.

What modifiers are commonly used with CPT 14301?

Common modifiers include: 58 for staged procedures during the global period, 59 for distinct procedures at separate sites, 78 for unplanned returns to OR for complications, 22 for unusually extensive procedures requiring extra work, and LT/RT for laterality. Modifier 51 may be appended for multiple procedures but is often added automatically by payers.

What are the Work RVUs for CPT code 14301?

CPT 14301 has a Work RVU of 12.65, Practice Expense RVU of 17.94 (non-facility) or 11.54 (facility), and Malpractice RVU of 2.06, totaling 32.65 total RVUs. This high RVU value reflects the significant surgical skill, time, and complexity required for tissue transfer procedures of this size.

Why would CPT 14301 be denied as not medically necessary?

Denials for medical necessity typically occur when documentation fails to justify why simple closure was inadequate, when procedures appear cosmetic rather than reconstructive, or when tissue transfer follows elective lesion removal without functional indication. To prevent denials, document wound tension, anatomical location constraints, functional impairment, or reconstruction following medically necessary excision (cancer, symptomatic lesions).