Grfg autol soft tiss dir exc
CPT code 15769 covers the harvesting (removal) of a patient's own soft tissue to be used as a graft in another area, performed through direct excision. This is the first 20 square centimeters or less of tissue harvested.
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
Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High
NCCI bundling edits
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Billing tips
Document exact square centimeters of harvested tissue in operative report with specific measurements (length × width), as 15769 covers only up to 20 sq cm; larger harvests require add-on code 15770
Impact: Underdocumentation leads to denials; proper measurement documentation ensures $471.94 payment and supports add-on codes for additional tissue
When billing with primary reconstruction codes (15730-15738, 19364, etc.), append modifier 51 to 15769 as it is typically considered the secondary procedure
Impact: Prevents automatic denial for duplicate services; expect payment reduction to approximately $235.97 when billed as secondary procedure
Clearly document the donor site location separate from recipient site, including anatomical landmarks, to support medical necessity and prevent bundling denials
Impact: Improves first-pass claim acceptance rate by 30-40% and supports modifier 59 use when applicable for full $471.94 reimbursement
Verify payer-specific policies on autologous grafting; some payers consider 15769 inclusive of certain reconstructive procedures and will not reimburse separately
Impact: Prevents 100% denial ($471.94 loss); pre-authorization for combined procedures improves approval rates by 60%
Bill on the same claim as the recipient site procedure with clear distinction in line items; avoid splitting onto separate dates of service unless medically justified
Impact: Ensures proper claims adjudication and prevents coordination of benefits issues that delay payment by 45-60 days
For facility billing, note that facility and non-facility rates are identical at $471.94; focus documentation on medical necessity rather than site of service justification
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