CPT 15758Surgery

Free fascial flap microvasc

CPT code 15758 covers the complex surgical procedure of harvesting and transplanting a free fascial flap (a layer of tissue) using microsurgical techniques to reconnect tiny blood vessels at the new site. This highly specialized reconstructive procedure restores tissue where it has been lost due to trauma, cancer removal, or other defects.

Showing rates for

National Average

Base Medicare rate

$2,191.15

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

36.9

PE RVU (NF)

25.12

MP RVU

5.72

Total RVU

67.74

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

NCCI bundling edits

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Billing tips

Document microvascular anastomosis details explicitly including vessel names, anastomosis technique (end-to-end vs end-to-side), suture type/size, and confirmation of flap perfusion
Impact: Critical for claim approval; missing microvascular documentation can trigger $2191.15 denial and downcode to simpler flap procedure (15734 at $1647.89)
Clearly identify donor site location and document it as separate from recipient site, including incision details and closure method for both sites
Impact: Prevents bundling denials and supports medical necessity; improper documentation risks 30-40% of claims requiring appeals
Use modifier 62 appropriately when two surgeons perform distinct, essential portions simultaneously rather than billing with modifier 80
Impact: Correct use of 62 yields $2738.94 total payment (2 surgeons × $1369.47) vs $2541.73 with 80 ($2191.15 + $350.58), but inappropriate use triggers audit
Bill on the date of flap transfer and anastomosis, not the date of planning or recipient site preparation if performed as separate staged procedures
Impact: Ensures proper global period assignment and prevents denials for incorrect date of service
Do not separately bill for operating microscope use (69990) as it is bundled into 15758 per NCCI edits
Impact: Prevents automatic denial and -$145 refund request; saves appeals time and potential fraud audit flags
For revisions within 90-day global period, append modifier 78 only if returning to OR for complication; use 58 for staged/planned procedures if separately identifiable
Proper modifier selection maintains payment eligibility; incorrect use results in 100% denial as included in global package

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Frequently asked questions

What is the Medicare reimbursement rate for CPT code 15758 in 2025?

The 2025 Medicare national average reimbursement for CPT 15758 is $2191.15 for both facility and non-facility settings. This rate is based on 67.74 total RVUs (36.9 work RVUs, 25.12 practice expense RVUs, and 5.72 malpractice RVUs) multiplied by the 2025 conversion factor of 32.3465.

What is the difference between CPT 15758 and 15756?

CPT 15758 describes a free fascial flap with microvascular anastomosis, while 15756 describes a free muscle or myocutaneous flap with microvascular anastomosis. The key difference is the tissue type: 15758 is for fascia (connective tissue layer) transfer, while 15756 is for muscle tissue with or without overlying skin. Documentation must clearly specify which tissue type was primarily harvested and transferred.

Can CPT 15758 be billed with a co-surgeon modifier?

Yes, modifier 62 is appropriate for CPT 15758 when two surgeons perform distinct essential portions of the procedure as co-surgeons, such as one surgeon harvesting the flap while another prepares the recipient site. Each surgeon would receive 62.5% of the Medicare allowable ($1369.47 each), and both must document their specific roles in separate operative notes.

Is operating microscope use separately billable with CPT 15758?

No, CPT 69990 (operating microscope) cannot be billed separately with 15758 as it is bundled per NCCI edits. Microvascular anastomosis inherently requires microscope use, which is included in the 15758 reimbursement. Attempting to bill 69990 separately will result in automatic denial.

What documentation is required to support medical necessity for CPT 15758?

Medical necessity documentation should include: the specific defect requiring reconstruction with size and location, why local or regional flaps are inadequate, clinical indication for fascial tissue specifically (such as need for thin, pliable coverage over exposed tendons or need for gliding surface), any previous failed reconstruction attempts, and how the free fascial flap addresses the functional or reconstructive goals that other options cannot achieve.

What is the global period for CPT 15758?

CPT 15758 has a 90-day global period. All routine postoperative care including flap monitoring, suture removal, and uncomplicated follow-up visits within 90 days are included in the $2191.15 reimbursement. Only complications requiring return to the OR, distinct new problems, or separately identifiable procedures can be billed during this period with appropriate modifiers.

How many RVUs is CPT code 15758 worth in 2025?

CPT 15758 has 67.74 total RVUs in 2025, consisting of 36.9 work RVUs, 25.12 practice expense RVUs (both facility and non-facility), and 5.72 malpractice RVUs. This high RVU value reflects the technical complexity and time required for microvascular free tissue transfer procedures.