CPT 15130Surgery

Drm agrft t/a/l 1st 100 sqcm

CPT code 15130 is used when a surgeon takes healthy skin from one part of your body and grafts it to another area (like a wound or burn), covering up to 100 square centimeters (about the size of a smartphone screen).

Showing rates for

National Average

Base Medicare rate

$701.60

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

7.53

PE RVU (NF)

12.78

MP RVU

1.38

Total RVU

21.69

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

NCCI bundling edits

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Billing tips

Calculate and document exact square centimeters in the operative report. Measurements must be recorded as length × width for rectangular grafts or calculated surface area for irregular shapes.
Impact: Underdocumented size leads to denials or downcoding to smaller graft codes. Each additional 100 sq cm beyond the first allows billing of add-on code 15131 at $208.61, significantly impacting total reimbursement.
Bill the donor site harvesting separately only when it requires separate closure beyond primary linear repair. Use 15130 for the recipient site and appropriate closure codes (12031-13153) for complex donor site closure.
Impact: Simple donor site closure is included in 15130 payment. Complex closure codes can add $150-400 in additional reimbursement when medically necessary and properly documented.
Verify anatomic site matches code descriptor (trunk/arms/legs only). Face, scalp, hands, feet, and genitalia require different codes (15135, 15155, 15175, 15200).
Impact: Incorrect anatomic coding results in automatic denials. Face and scalp grafts (15135) reimburse at $734.32, while hands/feet (15155) reimburse at $818.50—using wrong code costs $100+ either way.
For grafts performed on same day as excision or debridement, document medical necessity for graft versus alternative closure methods and use modifier 59 appropriately.
Impact: Payers often bundle debridement into graft codes. Proper modifier use and documentation preserves debridement reimbursement of $100-300 depending on depth and size.
Track the global period (90 days for 15130). Any unplanned returns to OR within this period require modifier 78 and separate documentation of complication or graft failure.
Impact: Billing without modifier 78 during global period results in 100% denial. With proper modifier, expect 60-70% reimbursement ($420-490) for revision procedures.

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 15130 in 2025?

The 2025 Medicare national average reimbursement for CPT 15130 is $701.60 in non-facility settings and $587.09 in facility settings. These rates are based on total RVUs of 21.69 multiplied by the 2025 conversion factor of 32.3465. Actual payment varies by geographic locality.

Can CPT 15130 and 15131 be billed together?

Yes, CPT 15131 is an add-on code specifically designed to be billed with 15130 when the graft size exceeds 100 square centimeters. Bill 15130 for the first 100 sq cm, then 15131 for each additional 100 sq cm or portion thereof. Both codes must be performed during the same operative session on the same anatomic region.

What's the difference between CPT 15130 and 15135?

CPT 15130 is used for dermal autografts on the trunk, arms, or legs, while CPT 15135 is for grafts on the face, scalp, eyelids, mouth, neck, ears, orbits, or genitalia. The anatomic location determines which code to use. 15135 reimburses at $734.32 (non-facility) compared to $701.60 for 15130.

Is donor site harvesting separately billable with CPT 15130?

No, routine donor site harvesting is included in CPT 15130 and not separately billable. However, if the donor site requires complex closure beyond simple linear repair due to size or anatomic complexity, you may bill appropriate intermediate (12031-12057) or complex (13100-13153) repair codes with proper documentation and modifier 59.

What documentation is required to bill CPT 15130 without denial risk?

Required documentation includes: exact graft measurements in square centimeters (length × width), specific anatomic location of both recipient and donor sites, type of graft (split vs full-thickness), medical necessity justification, wound bed preparation description, and fixation method. Photographs with measurement scales significantly reduce denial risk.

How many RVUs is CPT 15130 worth in 2025?

CPT 15130 has total RVUs of 21.69 for 2025, consisting of 7.53 work RVUs, 12.78 non-facility practice expense RVUs (9.24 facility), and 1.38 malpractice RVUs. This high RVU value reflects the complexity and resource intensity of skin grafting procedures.

What modifier should I use when performing bilateral skin grafts with CPT 15130?

Use modifier 50 for bilateral procedures or modifiers LT/RT to indicate laterality when grafting both sides during the same session. Additionally, modifier 59 may be needed to indicate distinct procedural services at different anatomic sites. Bilateral procedures typically receive 150% of the single procedure rate, though payer policies vary.