CPT 15572Surgery

Skin pedicle flap arms/legs

CPT 15572 covers a skin pedicle flap procedure on the arms or legs, where a surgeon moves skin tissue while keeping its original blood supply attached to cover a wound or defect. This reconstructive technique is used when simpler skin grafts won't work.

Showing rates for

National Average

Base Medicare rate

$863.65

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

10.12

PE RVU (NF)

14.78

MP RVU

1.8

Total RVU

26.7

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

NCCI bundling edits

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Billing tips

Always verify the anatomic location matches code descriptor (arms/legs only); torso or head/neck pedicle flaps require different CPT codes
Impact: Prevents 100% denial and potential recoupment; incorrect anatomic coding is among the top denial reasons for flap procedures
Document flap dimensions (length x width), donor site location, recipient site location, and vascular pedicle orientation in operative report
Impact: Reduces audit risk and supports medical necessity; missing measurements can trigger $863.65 payment recoupment during post-payment review
Bill facility vs. non-facility based on actual place of service; hospitals and ASCs use facility rate ($722.62) while office-based surgical suites use non-facility rate ($863.65)
Impact: Billing non-facility rate for hospital procedures results in $140.03 overpayment subject to recoupment and potential fraud investigation
Do not separately bill for simple donor site closure; this is included in 15572 base payment
Impact: Unbundling donor site repair can trigger $100-300 denials per case and flag practice for audit
For staged procedures, bill the flap creation (15572) separately from any subsequent division/inset procedures (use appropriate 15xxx codes for later stages)
Impact: Properly staged billing can generate additional $500-1,200 in legitimate reimbursement for multi-stage reconstructions
Append modifier 22 with detailed letter when flap size exceeds typical dimensions or involves unusual complexity, including comparison to standard procedure time and work
Can increase reimbursement by $172-432 (20-50% above base rate) but requires strong documentation; approval rate approximately 30-40%

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 15572 in 2025?

Medicare pays $863.65 for CPT 15572 in non-facility settings and $722.62 in facility settings (hospital/ASC) based on the 2025 national average rates. Actual payment may vary by geographic locality based on the GPCI adjustment factors for your area.

Can CPT 15572 be billed with excision codes on the same date of service?

Yes, but documentation must clearly support that the excision and flap reconstruction are distinct services. Use modifier 59 on the separately identifiable procedure and ensure the operative report shows the excision created the defect requiring flap coverage. Many payers will bundle these without proper modifier use and documentation.

What is the difference between CPT 15572 and a skin graft code?

CPT 15572 is a pedicle flap that maintains blood supply through an attached tissue bridge, while skin grafts (15100-15121) involve completely detached tissue relying on recipient bed for revascularization. Flaps are more complex, carry higher reimbursement, and are used when graft survival is unlikely due to poor recipient bed (exposed bone, tendon, or compromised vascularity).

How many RVUs is CPT code 15572 worth in 2025?

CPT 15572 has 26.7 total RVUs in 2025, broken down as: 10.12 work RVUs, 14.78 non-facility practice expense RVUs (10.42 facility PE RVUs), and 1.8 malpractice RVUs. This makes it a moderately high-value surgical procedure.

What body areas are covered under CPT 15572?

CPT 15572 specifically covers skin pedicle flaps on the arms and legs (upper and lower extremities) only. Pedicle flaps on the trunk, scalp, face, neck, hands, or feet require different CPT codes. Verify anatomic location carefully to avoid denials for incorrect coding.

Is CPT 15572 subject to a global surgical period?

Yes, CPT 15572 carries a 90-day global surgical period. This means routine postoperative care within 90 days is bundled into the payment. Any unplanned returns to the OR for complications require modifier 78, while planned staged procedures need modifier 58 to receive separate payment.

What documentation is needed to support medical necessity for CPT 15572?

Documentation must include defect measurements, explanation of why simpler closure methods (primary closure or skin graft) were inadequate, wound bed characteristics (exposed structures, poor vascularity), photographs when available, and description of tissue quality. Medical necessity is often challenged, so detailed justification is critical to avoid denials.