CPT 15220Surgery

Fth/gft fr s/a/l 20 sq cm/<

CPT 15220 covers a full-thickness skin graft (including epidermis and entire dermis) taken from one body area and transplanted to another area measuring 20 square centimeters or less. This is commonly used to repair wounds, burns, or surgical defects that cannot heal properly on their own.

Showing rates for

National Average

Base Medicare rate

$751.09

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

8.09

PE RVU (NF)

13.98

MP RVU

1.15

Total RVU

23.22

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

NCCI bundling edits

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Billing tips

Measure and document graft size in square centimeters precisely in the operative report, not just 'small' or 'large' - measurements determine code selection and are primary audit target
Impact: Prevents downcoding from 15220 to evaluation codes or denials; accurate documentation supports $751.09 vs potential $0 for lack of medical necessity
Document both donor site location (scalp, arm, or leg per code descriptor) and recipient site separately with anatomical specificity
Impact: Required for code validation; missing donor site documentation is top denial reason resulting in claim rejection until records amended
Do not separately bill recipient site preparation (CPT 15002-15005) on same date of service - it is bundled into 15220 per NCCI edits
Impact: Prevents automatic denial and recoupment; attempting to bill 15004 separately with 15220 results in $0 payment for preparation code
Bill adjacent tissue transfer/rearrangement codes (14000 series) and skin grafts separately only when performed at completely distinct anatomical sites with modifier 59
Impact: Without proper modifier and distinct site documentation, expect 100% denial of secondary procedure; with proper coding, receive full payment for both
Verify global period coordination - 15220 carries 90-day global; any related procedures within this window need modifier 58, 78, or 79 to receive payment
Impact: Unmodified claims during global period automatically deny; proper modifier use recovers $596.79-$751.09 that would otherwise be lost
For grafts larger than 20 sq cm, use add-on code 15221 for each additional 20 sq cm or part thereof - ensure total area is documented and calculation is shown

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 15220 in 2025?

The 2025 Medicare national average payment for CPT 15220 is $751.09 in non-facility settings (physician office) and $596.79 in facility settings (hospital/ASC). Actual rates vary by geographic locality based on GPCI adjustments.

How many RVUs is CPT code 15220 worth?

CPT 15220 has a total of 23.22 RVUs for 2025, consisting of 8.09 work RVUs, 13.98 non-facility practice expense RVUs (9.21 facility PE RVUs), and 1.15 malpractice RVUs.

Can I bill CPT 15220 with an excision code on the same day?

Yes, excision codes can be billed with 15220 when performed at the same site, as the excision creates the defect requiring grafting. However, recipient site preparation codes (15002-15005) are bundled into 15220 and cannot be separately billed per NCCI edits.

What is the difference between CPT 15220 and 15240?

CPT 15220 is for full-thickness skin grafts from scalp, arms, or legs measuring 20 sq cm or less, while CPT 15240 covers full-thickness grafts from forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, or feet of the same size. Code selection depends on donor site anatomical location.

How do I measure the graft size for CPT 15220?

Measure the actual graft size in square centimeters, calculated as length x width if rectangular, or using specific measurement tools for irregular shapes. Document the exact measurement in the operative report. Grafts up to and including 20 sq cm use 15220; anything larger requires add-on code 15221 for each additional 20 sq cm.

What is the global period for CPT 15220?

CPT 15220 has a 90-day global surgical period. All routine follow-up care related to the graft procedure within 90 days is included in the payment and cannot be separately billed unless complications arise or unrelated services are provided.

Does CPT 15220 require prior authorization from Medicare?

Standard Medicare does not typically require prior authorization for CPT 15220, but Medicare Advantage plans may have prior authorization requirements. Commercial payers vary widely - always verify specific payer requirements before scheduling. Medical necessity documentation should be comprehensive regardless of authorization requirements.