CPT 15576Surgery

Pedicle e/n/e/l/ntroral

CPT 15576 covers the surgical creation of a pedicled tissue flap (skin and underlying tissue that remains partially attached to maintain blood supply) to reconstruct or repair defects of the lip, nose, ear, or eyelid. This is a complex reconstructive procedure used when simpler closure techniques are inadequate.

Showing rates for

National Average

Base Medicare rate

$764.99

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

9.37

PE RVU (NF)

13.13

MP RVU

1.15

Total RVU

23.65

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

NCCI bundling edits

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Billing tips

Document exact anatomic location (lip, nose, ear, or eyelid) and specify the type of pedicled flap used (advancement, rotation, transposition, interpolation) in the operative report, as this distinguishes 15576 from other flap codes
Impact: Prevents downcoding to simpler procedures like adjacent tissue transfer (14060-14302 series) which reimburse $200-500 less
Never bundle 15576 with the excision code when performing Mohs reconstruction; the dermatologist bills the excision/Mohs code while the reconstructive surgeon bills 15576 separately on the same day
Impact: Preserves full $764.99 reimbursement; bundling inappropriately could result in complete denial of the flap code
Measure and document defect size and final flap dimensions in centimeters, including length and width, as payers increasingly request this information during audits
Impact: Reduces audit risk and supports medical necessity; lack of measurements is a leading cause of recoupment demands averaging $764.99 per case
Bill in the facility setting when performed in hospital or ASC to capture both professional fee ($634.96) and facility fee, rather than office setting which may not be equipped for complex flap procedures
Impact: Total reimbursement including facility fees can exceed $3,000-5,000 versus $764.99 professional-only in office
Submit claims with clear indication if this is a delayed or staged reconstruction (modifier 58) versus immediate reconstruction, as this affects global period application
Impact: Prevents automatic denial for services within 90-day global period of initial excision/trauma; secures full $764.99 payment
When performing revision or secondary flap procedure, thoroughly document why initial closure was inadequate and why the pedicled flap approach is medically necessary rather than cosmetic

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Frequently asked questions

What is the Medicare reimbursement for CPT 15576 in 2025?

Medicare pays $764.99 for CPT 15576 in the non-facility (office) setting and $634.96 in the facility (hospital/ASC) setting based on the 2025 national average rates. Actual payment may vary by geographic location based on local GPCI adjustments.

Can CPT 15576 be billed with an excision code on the same day?

Yes, CPT 15576 can be billed separately from excision codes (such as Mohs surgery or lesion excision) when the pedicled flap reconstruction is performed immediately following the excision. Ensure separate documentation of the excision and reconstruction procedures, and the reconstructive surgeon should bill 15576 if different from the excising surgeon.

What is the difference between CPT 15576 and adjacent tissue transfer codes 14060-14302?

CPT 15576 specifically covers pedicled flap formation for the lip, nose, ear, or eyelid with preserved vascular pedicle, representing more complex reconstructive work. Codes 14060-14302 describe simpler adjacent tissue transfers/rearrangements measured by defect size. CPT 15576 has higher work RVUs (9.37 vs 4.18-8.56) and should be used when flap complexity exceeds simple advancement or rotation.

How many work RVUs is CPT code 15576 worth?

CPT 15576 has 9.37 work RVUs, 13.13 practice expense RVUs (non-facility), 9.11 practice expense RVUs (facility), and 1.15 malpractice RVUs, for a total of 23.65 RVUs in the non-facility setting according to the 2025 Medicare Physician Fee Schedule.

Is CPT 15576 subject to a 90-day global period?

Yes, CPT 15576 carries a 90-day global surgical package, meaning routine post-operative care for 90 days after the procedure is included in the reimbursement. Complications requiring return to the OR should be billed with modifier 78, and staged/related procedures with modifier 58 to receive additional payment.

What modifier should I use when billing bilateral pedicled flaps to both ears?

Use modifier 50 (bilateral procedure) when performing pedicled flaps on both ears during the same operative session. This typically results in 150% reimbursement of the single procedure rate. Alternatively, some payers may require billing the code twice with RT and LT modifiers instead of modifier 50.

Does insurance cover CPT 15576 for cosmetic purposes?

No, CPT 15576 is only covered when performed for reconstructive purposes following trauma, tumor excision, congenital deformity correction, or functional impairment. Procedures performed solely to improve appearance without functional deficit or to correct defects from cosmetic procedures are not covered by Medicare or most commercial insurers and are patient responsibility.