CPT 15240Surgery

Fth/gft f/c/c/m/n/ax/g/h/f20

CPT 15240 covers a full-thickness skin graft procedure for areas like the face, scalp, eyelids, mouth, neck, ears, hands, or feet, when the graft size is 20 square centimeters or less. This involves transplanting all layers of skin from one body area to repair damaged or missing skin in these critical visible or functional locations.

Showing rates for

National Average

Base Medicare rate

$907.97

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

10.41

PE RVU (NF)

16.25

MP RVU

1.41

Total RVU

28.07

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

NCCI bundling edits

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Billing tips

Accurately measure and document graft size in square centimeters in the operative report, as crossing the 20 sq cm threshold requires billing 15241 instead, which reimburses at $1,159.04 non-facility
Impact: Incorrect size documentation can result in $251.07 underpayment or potential upcoding investigation if threshold not truly met
Do NOT separately bill for donor site closure when harvesting the full-thickness graft, as this is bundled into 15240 per NCCI edits
Impact: Separately billing donor closure (e.g., 12031-12037) will result in denial and potential prepayment review; this represents approximately $200-400 in inappropriate billing
Bill recipient site preparation (debridement codes 11042-11047) separately only if performed at a previous session or if extensive beyond typical graft bed preparation
Impact: When medically necessary and documented as distinct, can add $100-300 to the case; same-session routine preparation is bundled and will be denied
Use anatomic location-specific codes correctly: 15240 is specifically for face/scalp/eyelids/mouth/neck/ears/orbits/genitalia/hands/feet; grafts to trunk or arms/legs require different codes (15200 series)
Impact: Using wrong anatomic series can result in incorrect reimbursement variance of $200-500 and potential audit flags for pattern errors
For Medicare patients, verify the facility vs. non-facility setting is correctly indicated on the claim, as the reimbursement difference is $128.74 for this code
Impact: Place of service code errors can trigger automatic payment adjustments and recoupment; consistent errors may indicate systemic billing problems

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Related actions

Common denials

Medical necessity not established - payer deems repair could have been accomplished with simpler closure technique (e.g., primary closure, flap, split-thickness graft)

How to appeal: Submit detailed operative report highlighting defect size, anatomic location, tissue quality issues preventing simpler closure, and functional/cosmetic importance. Include clinical photos if available. Reference peer-reviewed literature supporting FTSG as standard of care for the specific defect characteristics. For tumor excisions, include pathology reports confirming diagnosis.

Bundling denial - payer bundles graft with tumor excision/Mohs surgery performed on same date

How to appeal: Cite CPT guidelines and CMS NCCI policy stating reconstructive procedures following Mohs surgery are separately reportable. Reference CPT Assistant (July 2010) clarifying that repair/reconstruction codes are not bundled with Mohs codes 17311-17315. Append modifier 59 if not originally included and resubmit with clear documentation showing distinct procedures.

Incorrect anatomic site - claim denied because documentation doesn't clearly support one of the specific anatomic areas included in 15240 definition

How to appeal: Resubmit with highlighted operative report sections clearly identifying the anatomic location (must be face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, or feet). Include anatomic diagrams if location ambiguity exists. If site was actually trunk/extremity, acknowledge coding error and resubmit with correct code (15200/15201).

Graft size documentation insufficient or conflicts with billed code - operative note lacks specific measurement or indicates size >20 sq cm

How to appeal: If measurement was actually documented but unclear, submit supplemental statement from surgeon clarifying the exact dimensions measured intraoperatively. If size was genuinely >20 sq cm, acknowledge error and submit corrected claim with 15241. If <20 sq cm but not initially documented, submit amendment to operative report with attestation of actual size if allowable under facility medical records policies and within appropriate timeframe.

Frequently asked questions

What is the Medicare reimbursement for CPT 15240 in 2025?

The 2025 Medicare national average reimbursement for CPT 15240 is $907.97 for non-facility settings and $779.23 for facility settings. Actual payment may vary based on geographic location and MAC adjustments.

Can I bill CPT 15240 with Mohs surgery codes on the same day?

Yes, CPT 15240 can be billed separately with Mohs surgery codes (17311-17315) when performed on the same day, as reconstruction following Mohs surgery is considered a distinct procedure. Use modifier 59 or XS to indicate the graft is a separate service and ensure documentation clearly shows both the Mohs excision and the subsequent reconstruction.

What is the difference between CPT 15240 and 15241?

CPT 15240 covers full-thickness skin grafts to specific anatomic areas (face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet) when the graft size is 20 square centimeters or less for the first area grafted. CPT 15241 is an add-on code for each additional 20 square centimeters or part thereof beyond the first 20 sq cm, and must be billed with 15240.

How many RVUs is CPT code 15240 worth?

CPT 15240 has a total of 28.07 RVUs for 2025, consisting of 10.41 work RVUs, 16.25 non-facility practice expense RVUs (12.27 facility PE RVUs), and 1.41 malpractice RVUs. This is a relatively high RVU value reflecting the complexity of full-thickness grafting procedures.

Can I bill for donor site closure separately when performing CPT 15240?

No, donor site closure is bundled into CPT 15240 and cannot be billed separately. NCCI edits specifically bundle intermediate and complex closure codes with skin graft harvest. The work and resources for donor site closure are included in the RVU values for 15240.

What documentation is required to support medical necessity for CPT 15240?

Documentation must include the clinical indication for grafting (trauma, tumor excision, burn, etc.), why a full-thickness graft is necessary rather than simpler closure methods, exact defect measurements, anatomic location, tissue quality assessment, and any factors preventing primary closure or alternative reconstruction. Photographs are helpful but not mandatory.

Does CPT 15240 have a global period?

Yes, CPT 15240 has a 90-day global surgical period. This means routine postoperative care for 90 days following the procedure is included in the reimbursement and cannot be billed separately. Complications requiring return to the operating room would require modifier 78, while staged/planned procedures would require modifier 58.