CPT 15274Surgery

Skn sub grft t/a/l child add

CPT 15274 is an add-on code used when a surgeon applies skin substitute grafts to the trunk, arms, or legs of a child, covering additional areas beyond the first 100 square centimeters. This code is billed in addition to the primary skin graft code for each additional 25 square centimeters or part thereof.

Showing rates for

National Average

Base Medicare rate

$76.98

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

0.8

PE RVU (NF)

1.42

MP RVU

0.16

Total RVU

2.38

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

NCCI bundling edits

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Billing tips

Calculate units precisely: divide total additional area (beyond first 100 sq cm) by 25, rounding up any fraction to the next whole unit
Impact: Each correctly billed unit adds $76.98 (non-facility) or $42.37 (facility); undercoding by even 1 unit costs $76.98 per case
Verify patient age is documented as 0-17 years in medical record; if patient is 18+, you must use CPT 15272/15278 series instead
Impact: Age documentation errors cause 100% claim denial; different code families have different base rates affecting total reimbursement
Always bill 15274 with primary code 15273; this add-on code cannot be billed alone and will reject without the base procedure
Impact: Standalone billing results in automatic denial; proper sequencing ensures $76.98 per unit reimbursement versus $0
Document exact square centimeters grafted in operative report with diagram showing anatomic locations; use standardized measurement tools
Impact: Precise measurement documentation reduces audit risk and supports multiple unit claims; vague descriptions trigger 30-40% denial rate
Submit product invoice or HCPCS code for the specific skin substitute used (e.g., Q4100-Q4226 series) separately from the application code
Impact: Skin substitute products can add $500-$5,000+ per case; failure to bill separately loses substantial product reimbursement
Review payer-specific policies on skin substitute coverage for pediatric patients; some require prior authorization for areas exceeding 200 sq cm
Impact: Obtaining prior auth prevents 100% denial on large grafts; retroactive auth attempts succeed only 15-20% of the time

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 15274 in 2025?

The 2025 Medicare national average rate for CPT 15274 is $76.98 in non-facility settings and $42.37 in facility settings. The total RVU is 2.38 (0.8 work RVU, 1.42 non-facility PE RVU, 0.35 facility PE RVU, and 0.16 MP RVU), calculated using the 2025 conversion factor of 32.3465.

How many times can I bill CPT 15274 on the same claim?

You can bill CPT 15274 multiple times based on the total area grafted beyond the initial 100 square centimeters. Calculate units by dividing the additional area by 25 square centimeters, rounding up any fraction. For example, if you graft 175 total sq cm, bill 15273 once (first 100 sq cm) and 15274 three times (75 additional sq cm ÷ 25 = 3 units).

Can CPT 15274 be billed for adult patients?

No, CPT 15274 is exclusively for pediatric patients aged 0-17 years. For adult patients (18 years and older), you must use the corresponding adult code series: CPT 15272 for the first 100 sq cm and 15278 for each additional 25 sq cm when grafting trunk, arms, legs, hands, or feet.

What is the difference between CPT 15273 and 15274?

CPT 15273 is the primary code for the first 100 square centimeters of skin substitute graft application in children, while CPT 15274 is the add-on code for each additional 25 square centimeters (or portion thereof) beyond the initial 100 sq cm. You must bill 15273 first, then add 15274 for additional units based on total area treated.

What documentation is required to support billing multiple units of CPT 15274?

Documentation must include: exact square centimeters grafted with measurement methodology, specific anatomic sites, patient age verification (0-17 years), type of skin substitute product used, medical necessity for the graft, and clear operative report details showing calculations that justify the number of units billed. Diagrams or photographs with measurements significantly strengthen claims.

Does CPT 15274 include the cost of the skin substitute product?

No, CPT 15274 covers only the physician work of applying the skin substitute graft. The actual skin substitute product must be billed separately using the appropriate HCPCS Q-code (Q4100-Q4226 series) or product-specific code with supporting invoice documentation. Failure to bill the product separately results in lost reimbursement for the expensive graft material.

What are common modifiers used with CPT 15274?

Common modifiers include: 59 (distinct procedural service for non-contiguous anatomic sites), 22 (increased procedural services for unusual complexity), 76 (repeat procedure by same physician), 78 (return to OR during global period), and LT/RT (laterality for bilateral extremities). Modifier 59 is particularly important when grafting multiple separate anatomic areas to prevent inappropriate bundling denials.