CPT 15840Surgery

Nerve palsy fascial graft

CPT code 15840 covers a surgical procedure where a surgeon takes tissue (fascia) from one part of the body and uses it to support facial muscles weakened by nerve damage, helping restore facial movement and appearance.

Showing rates for

National Average

Base Medicare rate

$983.01

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

14.99

PE RVU (NF)

13.13

MP RVU

2.27

Total RVU

30.39

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

NCCI bundling edits

Loading bundling edits…

Billing tips

Document the specific diagnosis code for facial nerve palsy (G51.0 for Bell's palsy, I69.392 for post-stroke facial weakness) as primary diagnosis, not cosmetic concern
Impact: Prevents automatic denial as cosmetic procedure, protecting full $983.01 reimbursement
Separately document and code the graft harvest site and technique in operative note, as some payers may allow additional payment for complex harvest from fascia lata
Impact: May justify add-on code or modifier 22 for additional $150-$300 depending on complexity
Include preoperative photographs showing facial asymmetry and functional deficits (inability to close eye, smile asymmetry) in medical record
Impact: Reduces denial rate by approximately 35% and expedites prior authorization approval
Verify that procedure is performed more than 6-12 months after nerve injury onset, as most payers require failed conservative management documentation
Impact: Prevents medical necessity denials that can delay payment 45-90 days or result in full denial
Code facility vs non-facility correctly; this procedure has identical rates ($983.01) but ensure ASC/hospital setting matches claim form
Impact: Prevents claim rejection and reprocessing delays of 30-60 days
When billing with blepharoplasty or brow lift codes, use modifier 59 and document medical necessity separately for each procedure to avoid bundling
Impact: Protects against bundling edits that could reduce combined payment by $400-$800

Live Field Datano reports yet

Real billers contribute denial patterns and appeal strategies for this code. Once 5+ reports come in, you’ll see live aggregated data here — the only place this exists, free.

Working with CPT 15840?

Get the free Revenue Protection Toolkit — the denial triggers, modifier pitfalls, and bundling conflicts that quietly cost you reimbursement. Instant download.

Help build the field knowledge

MedPayIQ gets smarter as billers contribute. If you've had this code denied, share what happened so others learn from it. Anonymous, no patient info.

Related actions

Frequently asked questions

What is the Medicare reimbursement rate for CPT code 15840 in 2025?

The 2025 Medicare national average payment for CPT 15840 is $983.01 for both facility and non-facility settings. This rate is based on 30.39 total RVUs (14.99 work + 13.13 PE + 2.27 MP) multiplied by the 2025 conversion factor of 32.3465.

Is CPT 15840 covered by Medicare as medically necessary?

Yes, CPT 15840 is covered by Medicare when performed for reconstructive purposes to treat facial nerve palsy with documented functional impairment. It is not covered for purely cosmetic facial enhancement. Documentation must demonstrate failed conservative treatment and functional deficits such as inability to close the eye, oral incompetence, or significant facial asymmetry affecting quality of life.

What diagnosis codes support medical necessity for CPT 15840?

Primary diagnosis codes include G51.0 (Bell's palsy), I69.392 (facial weakness following cerebrovascular disease), G51.8 (other disorders of facial nerve), S04.5xxA (injury of facial nerve), and C71.9 (malignant neoplasm of brain) when palsy results from tumor resection. The diagnosis must clearly link facial nerve dysfunction to the need for fascial graft reconstruction.

Can CPT 15840 be billed with blepharoplasty codes?

CPT 15840 can be billed with blepharoplasty (15820-15823) if procedures are distinct and separately necessary, but modifier 59 is typically required to bypass NCCI bundling edits. Documentation must clearly show that the blepharoplasty addresses functional issues separate from the nerve palsy graft (e.g., excess upper lid skin plus lagophthalmos requiring graft support). Many payers scrutinize these combinations for cosmetic intent.

How many RVUs is CPT code 15840 worth?

CPT 15840 has 30.39 total RVUs for 2025, comprised of 14.99 work RVUs, 13.13 practice expense RVUs (both facility and non-facility), and 2.27 malpractice RVUs. This makes it a high-complexity surgical procedure in terms of relative value.

What modifiers are commonly used with CPT 15840?

Common modifiers include LT/RT (laterality), modifier 50 (bilateral procedure), modifier 22 (increased procedural services for complex cases), modifier 59 (distinct procedural service when billed with other facial procedures), and modifier 78 (return to OR during postoperative period). Laterality modifiers are particularly important for proper claim adjudication.

Does CPT 15840 have a global period?

Yes, CPT 15840 has a 90-day global surgical period. This means all routine postoperative care for 90 days after surgery is included in the $983.01 payment. Complications requiring return to the operating room during this period require modifier 78 or 79 depending on whether the subsequent procedure is related or unrelated.