CPT 15131Surgery

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CPT 15131 is an add-on code for additional skin grafts taken from the patient's own body (dermal autograft) applied to the trunk, arms, or legs. It's billed for each additional 100 square centimeters (or part thereof) beyond the first graft.

Showing rates for

National Average

Base Medicare rate

$95.42

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

1.5

PE RVU (NF)

1.17

MP RVU

0.28

Total RVU

2.95

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

NCCI bundling edits

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Billing tips

Calculate units precisely by dividing total additional graft area (beyond first 100 sq cm) by 100, rounding up any fraction. For example, 275 sq cm total = 1 primary code + 2 units of 15131.
Impact: Accurate unit calculation can mean difference between $95.42 (1 unit) and $190.84 (2 units) in additional revenue
Always pair 15131 with the appropriate primary dermal autograft code (15130 for trunk/arms/legs first 100 sq cm). Never bill 15131 as a standalone code.
Impact: Standalone billing results in automatic denial; proper pairing ensures payment of both primary code and all add-on units
Document exact surface area measurements in operative notes using standardized methods (ruler measurement, body surface area charts, or Lund-Browder diagrams for burns).
Impact: Specific measurements prevent 30-40% denial rate for insufficient documentation and support medical necessity during audits
Bill facility vs non-facility based on actual site of service. Non-facility rate ($95.42) applies to office-based or physician-owned ASC; facility rate ($87.01) applies to hospital settings.
Impact: Incorrect place of service designation results in $8.41 per unit difference and may trigger recoupment
For pediatric patients under age 10, document percentage of body surface area as alternative to sq cm measurement, as per code descriptor allowing either method.
Impact: Proper documentation method for pediatric cases reduces denial risk and supports age-appropriate billing practices
Submit claims with primary codes in the sequence required by CPT: list primary graft code first (15130), then add-on code(s) 15131 with appropriate units.

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 15131 in 2025?

Medicare pays $95.42 for CPT 15131 in non-facility settings and $87.01 in facility settings based on the 2025 Physician Fee Schedule. The total RVU is 2.95 with a conversion factor of 32.3465.

Can CPT 15131 be billed alone or does it require a primary code?

CPT 15131 cannot be billed alone. It is an add-on code that must be paired with primary dermal autograft code 15130. Claims submitted with 15131 as a standalone service will be denied automatically.

How do I calculate units for CPT 15131?

Calculate units by determining total graft area beyond the first 100 sq cm covered by the primary code. Divide additional area by 100 and round up any fraction. For example, if total grafted area is 325 sq cm, bill 15130 once and 15131 for 3 units (225 additional sq cm ÷ 100 = 2.25, rounded to 3).

What anatomic sites are covered by CPT 15131?

CPT 15131 applies to dermal autografts on the trunk, arms, legs, hands, and feet. It does not cover face, eyelids, mouth, neck, ears, orbits, genitalia, or scalp, which have separate CPT codes (15135-15136 for those areas).

What is the difference between facility and non-facility rates for 15131?

The non-facility rate ($95.42) applies when the procedure is performed in a physician's office or physician-owned ambulatory surgery center where the practice incurs facility costs. The facility rate ($87.01) applies when performed in a hospital or hospital-owned facility that bills separately for facility fees.

What modifiers are commonly used with CPT 15131?

Common modifiers include 59 for distinct procedural service when grafting separate anatomic sites, LT/RT for laterality on extremities, and 78 for related procedures during postoperative period. Modifier 51 should NOT be used as 15131 is an add-on code exempt from multiple procedure reductions.

What documentation is required to support billing multiple units of 15131?

Documentation must include precise surface area measurements in square centimeters (or percentage of body surface area for children), anatomic locations of all graft sites, clear description of total area grafted, and detailed operative notes supporting medical necessity for each unit billed. Diagrams or body maps significantly strengthen documentation.