CPT 15731Surgery

Forehead flap w/vasc pedicle

CPT 15731 covers a forehead flap procedure where a section of forehead tissue with its blood supply attached is surgically moved to reconstruct damaged areas of the face, typically the nose. This complex reconstructive surgery maintains blood flow through a vascular pedicle (connecting tissue containing blood vessels).

Showing rates for

National Average

Base Medicare rate

$1,094.93

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

14.38

PE RVU (NF)

17.32

MP RVU

2.15

Total RVU

33.85

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

NCCI bundling edits

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Billing tips

Document vascular pedicle preservation explicitly in operative report with specific artery identified (supratrochlear vs supraorbital) and flap dimensions; this distinguishes 15731 from advancement flaps or grafts
Impact: Prevents downcoding to lower-value codes like 14060-14061 (adjacent tissue transfer) which reimburse $400-600 less; critical documentation element for audits
Bill facility vs non-facility correctly based on actual site of service; ASC and hospital outpatient are facility settings ($973.31) while office-based surgical suites may qualify for non-facility rate ($1094.93)
Impact: $121.62 difference in Medicare reimbursement; verify place of service code matches actual setting (POS 22/24 for facility, POS 11 for office)
Do NOT bill 15731 with the initial tumor excision/Mohs surgery code on same date if performed by same surgeon; forehead flap is considered part of the reconstruction, not the excision
Impact: Prevents bundling denials and audit flags; if same surgeon performs both, only reconstruction is billable unless excision meets modifier 59 criteria with distinct session documentation
For second-stage pedicle division (typically 2-3 weeks later), bill appropriate code (15630 or intermediate/complex repair code depending on technique) with modifier 58, not 15731 again
Impact: Ensures proper staged procedure payment; billing 15731 twice will result in denial; second stage typically reimburses $200-400 depending on complexity
Link diagnosis code clearly indicating medical necessity for complex flap reconstruction (malignant neoplasm codes, traumatic injury codes, not just 'defect'); include defect size in documentation
Impact: Reduces medical necessity denials; defects <1.5 cm may face scrutiny as not requiring forehead flap complexity; diagnosis code alignment critical for approval

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Frequently asked questions

What is the Medicare reimbursement rate for CPT code 15731 in 2025?

The 2025 Medicare national average reimbursement for CPT 15731 is $1,094.93 in non-facility settings (physician office with surgical suite) and $973.31 in facility settings (hospital outpatient or ASC). Actual rates may vary by geographic location based on locality adjustments.

Can CPT 15731 be billed with Mohs surgery on the same day?

Generally no, if the same surgeon or same group performs both procedures. The reconstruction (15731) is considered part of the surgical defect management. However, if a different specialty surgeon performs the reconstruction in a truly separate session with distinct documentation, modifier 59 may allow separate billing, though this remains high audit risk.

How do I bill the second stage of a forehead flap when the pedicle is divided?

The pedicle division performed 2-3 weeks after the initial forehead flap is billed separately using CPT 15630 (delay of flap) or appropriate closure code with modifier 58 to indicate a planned staged procedure. Do not bill 15731 again for the second stage.

What is the global period for CPT code 15731?

CPT 15731 has a 90-day global period, meaning all routine post-operative care including follow-up visits, suture removal, and minor adjustments within 90 days are included in the $1,094.93 reimbursement and cannot be billed separately.

What documentation is required to support medical necessity for CPT 15731?

Required documentation includes defect size with measurements, location with anatomical detail, depth (full-thickness typically required), explanation of why simpler techniques are inadequate, identification of the specific vascular pedicle preserved, and diagnosis codes clearly indicating malignancy, trauma, or condition necessitating complex vascularized reconstruction.

What are the work RVUs for CPT 15731 in 2025?

CPT 15731 has 14.38 work RVUs, 17.32 practice expense RVUs (non-facility), 13.56 practice expense RVUs (facility), and 2.15 malpractice RVUs, totaling 33.85 total RVUs in non-facility settings, reflecting the complexity and physician work involved in forehead flap reconstruction.

What specialties typically bill CPT code 15731?

CPT 15731 is most commonly billed by plastic surgeons, facial plastic surgeons, otolaryngologists (ENT), dermatologic surgeons with advanced reconstruction training, and oculoplastic surgeons who specialize in facial reconstruction, particularly following Mohs surgery or trauma.