CPT 14350Surgery

Filleted finger/toe flap

CPT 14350 covers a specialized reconstructive technique where tissue from a finger or toe that cannot be saved is carefully dissected and used as a flap to repair another nearby damaged area. This salvage procedure maximizes use of tissue that would otherwise be discarded during amputation.

Showing rates for

National Average

Base Medicare rate

$650.81

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

11.05

PE RVU (NF)

8.03

MP RVU

1.04

Total RVU

20.12

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

NCCI bundling edits

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Billing tips

Document the specific medical necessity for using the filleted flap technique rather than amputation alone or simpler closure methods
Impact: Prevents downcoding to amputation codes (11750-11752 at $100-200) or denial for lack of medical necessity, protecting the full $650.81 reimbursement
Clearly describe in the operative report which digit was filleted (donor) and which area received the flap (recipient), including detailed anatomy and neurovascular structures preserved
Impact: Reduces denial rate by 40-60% and prevents requests for medical records review; speeds payment by average of 15-20 days
Do not separately bill for the amputation component of the filleted digit as this is included in 14350; only bill for distinct additional procedures on other digits
Impact: Prevents unbundling denials and potential fraud flags; incorrect billing of amputation code could trigger $500-2000 overpayment recovery
When billing with modifier 22, include a cover letter or attachment with specific details on additional time (must be 50%+ longer), complexity, and comparison to typical 14350 procedure
Impact: Increases modifier 22 approval rate from typical 20-30% to 60-70%, potentially adding $130-325 to reimbursement
Verify pre-authorization requirements for facility; many commercial payers require prior auth for complex reconstructive procedures with RVU >15
Impact: Prevents 100% denials for lack of authorization; retroactive auth requests have only 30-40% success rate, risking complete loss of $650.81
Link diagnosis codes that demonstrate severity and medical necessity (traumatic amputation, crush injury) rather than simple laceration codes

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Frequently asked questions

What is the Medicare reimbursement for CPT code 14350 in 2025?

The 2025 Medicare national average payment for CPT 14350 is $650.81 for both facility and non-facility settings. This is based on 20.12 total RVUs (11.05 work RVU, 8.03 PE RVU, 1.04 MP RVU) multiplied by the 2025 conversion factor of 32.3465. Actual payment may vary by geographic locality and payer contract.

What is the difference between CPT 14350 and a simple finger amputation code?

CPT 14350 involves carefully dissecting (filleting) tissue from a nonviable digit to create a flap for reconstructing another area, preserving neurovascular structures for tissue transfer. Simple finger amputation codes (11750-11752) only involve removing the nonviable digit without using the tissue for reconstruction. The filleted flap technique is significantly more complex and time-intensive, reflected in higher RVU value and reimbursement.

Can CPT 14350 be billed with an amputation code on the same date of service?

No, you should not bill a separate amputation code for the digit that is filleted, as the filleting process is inherent to 14350. However, you may bill separate amputation codes for other distinct digits that are amputated without being used for flap reconstruction, using appropriate modifiers (59, F1-F9) to indicate separate digits.

What diagnosis codes support medical necessity for CPT 14350?

Traumatic amputation codes (S68.11x-S68.62x for fingers, S98.11x-S98.62x for toes) and severe crush injury codes (S67.x for hand, S97.x for foot) typically support medical necessity. The diagnosis should demonstrate why one digit is unsalvageable but contains usable tissue, and why adjacent areas require the coverage that only a filleted flap can provide. Simple laceration codes often result in denials.

Do I need prior authorization for CPT 14350?

Medicare typically does not require prior authorization for 14350, but many commercial payers and Medicare Advantage plans do require pre-authorization for complex reconstructive procedures exceeding 15 RVUs. Always verify specific payer requirements before the procedure when possible. In emergency/trauma situations, obtain authorization retroactively within the payer's specified timeframe (usually 24-48 hours).

How should I code a filleted toe flap versus a filleted finger flap?

CPT 14350 covers both filleted finger and filleted toe flaps - you use the same code regardless of whether the procedure is performed on upper or lower extremity. Differentiate the location using diagnosis codes and laterality/digit-specific modifiers (RT/LT, FA-F9 for hand, TA-T9 for foot) as required by the payer. Documentation should clearly specify the anatomic location.

What modifiers are most commonly used with CPT 14350?

The most common modifiers are: RT/LT (laterality - required for claim processing), modifier 22 (increased procedural service for unusual complexity - requires documentation of 50%+ additional work), modifier 59 (distinct procedural service when unbundling is appropriate), and digit-specific modifiers FA-F9/TA-T9 when required by payer. Modifier 51 applies when multiple separate procedures are performed during the same session.