CPT 15574Surgery

Pedcle fh/ch/ch/m/n/ax/g/h/f

CPT 15574 covers the surgical transfer of a pedicle flap (tissue that remains attached to its original blood supply) to reconstruct areas of the face, scalp, eyelids, mouth, neck, ears, arms, legs, hands, or feet. This complex procedure moves living tissue while keeping it connected to its nutrient source.

Showing rates for

National Average

Base Medicare rate

$839.72

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

10.7

PE RVU (NF)

13.69

MP RVU

1.57

Total RVU

25.96

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

NCCI bundling edits

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Billing tips

Document flap dimensions, donor site location, recipient site location, and vascular pedicle anatomy in operative note
Impact: Prevents denials for insufficient documentation; critical for supporting medical necessity and distinguishing from simpler closure codes
Do not separately bill for simple repair/closure of the donor site—it is bundled into 15574
Impact: Unbundling donor site closure can trigger $200-400 in recoupments plus potential fraud investigation
Bill in the non-facility setting when performed in office-based surgical suite to capture additional $132.30 per procedure
Impact: Non-facility rate ($839.72) vs facility rate ($707.42) = $132.30 difference per case
For staged pedicle flaps requiring division, bill the second stage with appropriate CPT code (15572 or 15650) with modifier 58
Impact: Ensures full reimbursement for planned second stage; failure to use modifier 58 may result in bundling denial
Verify that defect creation code (e.g., excision, Mohs surgery) is billed separately by the appropriate provider if different from flap surgeon
Impact: Coordination prevents duplicate billing while ensuring all services are captured; particularly important in Mohs reconstruction scenarios
Use modifier 22 only when complexity significantly exceeds typical procedure and operative time is 30%+ longer with detailed documentation
Impact: Successful modifier 22 claims can increase reimbursement by $168-250, but poorly documented claims face automatic denial

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 15574 in 2025?

The 2025 Medicare national average reimbursement for CPT 15574 is $839.72 for non-facility settings and $707.42 for facility settings, based on the CMS Physician Fee Schedule with a conversion factor of 32.3465.

How many RVUs is CPT code 15574 worth?

CPT 15574 has 25.96 total RVUs, consisting of 10.7 work RVUs, 13.69 practice expense RVUs (non-facility), 9.6 practice expense RVUs (facility), and 1.57 malpractice RVUs.

Can I bill CPT 15574 with an excision code on the same day?

Yes, but with careful documentation. The excision creating the defect and the flap reconstruction are separately billable services when performed by the same surgeon, but you must clearly document each as distinct procedures. Some payers may require modifier 59 to prevent bundling denials.

What is the difference between CPT 15574 and 15572?

CPT 15574 covers pedicle flaps to the face, scalp, eyelids, mouth, neck, ears, orbit, genitalia, hands, and feet (complex anatomic areas), while 15572 covers pedicle flaps to the trunk, with different anatomic complexity and typically different reimbursement rates.

Is donor site closure included in CPT 15574?

Yes, closure of the donor site is bundled into CPT 15574 and should not be billed separately. Only the flap procedure itself should be reported; billing donor site closure as a separate repair code constitutes unbundling and may trigger recoupment.

How do I bill for a two-stage pedicle flap procedure?

Bill the initial flap transfer with CPT 15574, then bill the second stage (pedicle division and inset) with the appropriate code (often 15572 or 15650) appended with modifier 58 to indicate a staged or related procedure during the postoperative period.

What documentation is required to support medical necessity for CPT 15574?

You must document defect size and location, explain why simpler closure methods (primary closure, skin graft) are inadequate for the specific defect, describe flap design with vascular pedicle preservation, and detail recipient site preparation. Include measurements, anatomic landmarks, and functional/aesthetic considerations that necessitate pedicle flap reconstruction.