CPT 15260Surgery

Fth/gft fr n/e/e/l 20 sqcm/<

CPT 15260 covers a full-thickness skin graft procedure for wounds on the nose, ears, eyelids, or lips when the graft size is 20 square centimeters or smaller. This involves transplanting all layers of skin from one body area to repair damaged or missing skin in these highly visible facial areas.

Showing rates for

National Average

Base Medicare rate

$977.83

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

11.64

PE RVU (NF)

17.21

MP RVU

1.38

Total RVU

30.23

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

NCCI bundling edits

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Billing tips

Measure and document exact graft dimensions in square centimeters in operative note, not just linear measurements; calculate area using length × width formula
Impact: Prevents downcoding to smaller size codes; accurate measurement maintains full $977.83 vs potential $150-200 reduction if downcoded
Bill donor site repair separately using CPT 15260 for recipient site and appropriate closure code (12031-13153) for donor site; these are separately reimbursable
Impact: Additional $200-600 reimbursement depending on donor site closure complexity; commonly missed revenue opportunity
Verify anatomic site (nose/ear/eyelid/lip) is explicitly documented; if graft extends to cheek or neck, code changes to 15240 series with lower reimbursement
Impact: Site specificity maintains 15260 rate of $977.83 vs $827.16 for 15240; $150 difference per incorrect code assignment
Submit facility claims with POS 22 (on-campus outpatient hospital) or 24 (ASC) to receive facility rate; office-based suite uses POS 11 for non-facility rate
Impact: Correct POS coding ensures appropriate rate payment; $150.41 differential between non-facility and facility rates
When billing with Mohs surgery (17311-17315), append modifier 59 to 15260 only if performed after Mohs pathologic confirmation and documented as separate session
Impact: Avoids bundling denial; proper modifier use secures full payment versus 100% denial ($977.83 at risk)
For grafts exactly at 20 sq cm threshold, round to 20 and use 15260; if even 21 sq cm, must use add-on code 15261; document rounding methodology
Prevents upcoding allegations while maximizing appropriate reimbursement; ensures compliance during audits

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 15260 in 2025?

The 2025 Medicare national average reimbursement for CPT 15260 is $977.83 for non-facility settings and $827.42 for facility settings. Actual payment may vary based on geographic locality adjustments using the GPCI index for your specific region.

Can I bill CPT 15260 with Mohs surgery on the same day?

Yes, CPT 15260 can be billed with Mohs surgery codes (17311-17315) when the graft is performed after pathologic confirmation of clear margins and represents a separate reconstructive decision. Append modifier 59 to 15260 to indicate it is a distinct procedural service, and document the graft as a separate procedure performed after tumor clearance.

What anatomic sites qualify for CPT 15260 versus 15240?

CPT 15260 is specific to full-thickness grafts on the nose, eyelids, ears, and lips. CPT 15240 covers grafts to the forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, and feet. If the graft spans both areas, code based on the primary/majority location and document clearly.

How do I measure graft size in square centimeters for accurate coding?

Measure the length and width of the actual graft tissue in centimeters (not the defect size necessarily), then multiply length × width to calculate square centimeters. Document both linear measurements and the calculated area in your operative note. For irregular shapes, approximate using the largest length and width dimensions.

Is the donor site closure separately billable with CPT 15260?

Yes, donor site closure is separately billable using intermediate (12031-12057) or complex (13100-13153) repair codes depending on closure complexity. Simple donor site closures are included in the graft code, but layered closures qualify for separate billing. This can add $200-600 to total reimbursement.

What is the global period for CPT 15260?

CPT 15260 has a 90-day global surgical period. All routine postoperative care including dressing changes, suture removal, and follow-up visits within 90 days are included in the reimbursement. Complications requiring return to OR should be billed with modifier 78, and staged procedures with modifier 58.

What are the total RVUs for CPT 15260 in 2025?

CPT 15260 has 30.23 total RVUs in 2025, consisting of 11.64 work RVUs, 17.21 non-facility practice expense RVUs (12.56 facility PE RVUs), and 1.38 malpractice RVUs. This high RVU value reflects the technical complexity and physician work involved in full-thickness facial grafting.