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Summary & Overview

CPT 15100: Split-Thickness Autograft for Trunk, Arms, or Legs

CPT code 15100 represents a split-thickness autograft procedure for the trunk, arms, or legs, covering the first 100 cm² or less, or one percent of the body area in infants and children. This procedure is a critical intervention for patients with severe skin injuries, such as burns, and is commonly performed in hospital outpatient settings. Nationally, this code is recognized by major payers including Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare, ensuring broad coverage for patients requiring skin grafts.

This publication provides a comprehensive overview of CPT 15100, including payer coverage, clinical context, and relevant benchmarks. Readers will gain insight into policy updates, typical sites of service, and the importance of this procedure in surgical and critical care settings. The summary also highlights associated taxonomies and related codes, offering a clear understanding of how this autograft procedure fits within broader clinical and billing practices. The information is designed to support healthcare professionals, administrators, and policy analysts in navigating the complexities of medical billing and reimbursement for skin replacement procedures.

AetnaBlue Cross Blue ShieldCigna HealthMedicareUnitedHealthcareCPT 15100split-thickness autograftskin replacementhospital outpatientburn treatmentsurgical proceduremedical billingplastic surgerycritical careclinical benchmarks

CPT Code Overview

CPT 15100 is used to report a split-thickness autograft procedure involving the trunk, arms, or legs. This code applies when the graft covers the first 100 cm² or less, or one percent of the body area in infants and children, excluding procedures described by CPT 15050. The service is classified as a skin replacement/autograft procedure and is typically performed in a hospital outpatient setting under Ambulatory Payment Classification (APC) 5054. This procedure is essential for treating significant skin injuries, such as burns, where skin grafting is required to promote healing and restore function.

Clinical & Coding Specifications

Clinical Context

A patient, often a child or adult, presents to the hospital outpatient department with a significant burn injury involving the trunk, arms, or legs. The burn may cover up to 100 cm² or one percent of the body area in infants and children. After initial wound assessment and stabilization, the surgical team determines that a split-thickness skin autograft is required to promote healing and restore skin integrity. The procedure involves harvesting a thin layer of skin from a donor site on the patient's body and grafting it onto the affected area. The workflow includes preoperative evaluation, anesthesia, graft harvesting, placement, and postoperative care. The service is typically performed by a surgery or plastic surgery physician.

Coding Specifications

Modifier 59: Distinct procedural service – used when multiple grafts are performed on different anatomical sites during the same day. This modifier distinguishes each graft as a separate procedure.

Provider Taxonomy Code	Specialty Name
`208600000X`	Surgery Physician
`208800000X`	Plastic Surgery Physician
`2086S0122X`	Surgical Critical Care Physician

Surgery Physician: General surgeons performing skin grafts.
Plastic Surgery Physician: Specialists in reconstructive procedures, including skin grafts.
Surgical Critical Care Physician: Physicians managing complex surgical patients, including those requiring skin grafts after trauma or burns.

Related Diagnoses

T20.00XA: Burn of unspecified degree of head, face, and neck, initial encounter
- Relevant when burns affect the head, face, or neck, potentially requiring skin grafting.
T21.00XA: Burn of unspecified degree of trunk, initial encounter
- Indicates burns to the trunk, which is directly addressed by the procedure described in 15100.
T22.00XA: Burn of unspecified degree of shoulder and upper limb, except wrist and hand, initial encounter
- Pertains to burns on the shoulder and upper limb, areas covered by 15100.
T23.001A: Burn of unspecified degree of wrist and hand, initial encounter
- Used for burns on the wrist and hand, which may require grafting procedures.
T24.00XA: Burn of unspecified degree of hip and lower limb, except ankle and foot, initial encounter
- Applies to burns on the hip and lower limb, also within the scope of 15100 for skin replacement.

Related CPT Codes

15120: Split‑thickness autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; first 100 cm² or less, or 1% of body area of infants and children.
- Used for autografts on more delicate or specialized anatomical sites. May be performed in conjunction with 15100 if multiple areas require grafting.
15050: Pinch graft(s), up to 2 cm diameter, to cover small ulcers, fingertips, or other small areas.
- Used for small, localized skin defects. Typically an alternative to 15100 for minor wounds or ulcers.
These codes are selected based on the size and location of the area requiring grafting. Modifier 59 may be used when multiple grafts are performed on different sites during the same encounter.

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Summary & Overview

CPT 15100: Split-Thickness Autograft for Trunk, Arms, or Legs

CPT Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifier 59: Distinct procedural service – used when multiple grafts are performed on different anatomical sites during the same day. This modifier distinguishes each graft as a separate procedure.

Provider Taxonomy Code	Specialty Name
`208600000X`	Surgery Physician
`208800000X`	Plastic Surgery Physician
`2086S0122X`	Surgical Critical Care Physician

Surgery Physician: General surgeons performing skin grafts.
Plastic Surgery Physician: Specialists in reconstructive procedures, including skin grafts.
Surgical Critical Care Physician: Physicians managing complex surgical patients, including those requiring skin grafts after trauma or burns.

Related Diagnoses

T20.00XA: Burn of unspecified degree of head, face, and neck, initial encounter
- Relevant when burns affect the head, face, or neck, potentially requiring skin grafting.
T21.00XA: Burn of unspecified degree of trunk, initial encounter
- Indicates burns to the trunk, which is directly addressed by the procedure described in 15100.
T22.00XA: Burn of unspecified degree of shoulder and upper limb, except wrist and hand, initial encounter
- Pertains to burns on the shoulder and upper limb, areas covered by 15100.
T23.001A: Burn of unspecified degree of wrist and hand, initial encounter
- Used for burns on the wrist and hand, which may require grafting procedures.
T24.00XA: Burn of unspecified degree of hip and lower limb, except ankle and foot, initial encounter
- Applies to burns on the hip and lower limb, also within the scope of 15100 for skin replacement.

Related CPT Codes

15120: Split‑thickness autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; first 100 cm² or less, or 1% of body area of infants and children.
- Used for autografts on more delicate or specialized anatomical sites. May be performed in conjunction with 15100 if multiple areas require grafting.
15050: Pinch graft(s), up to 2 cm diameter, to cover small ulcers, fingertips, or other small areas.
- Used for small, localized skin defects. Typically an alternative to 15100 for minor wounds or ulcers.
These codes are selected based on the size and location of the area requiring grafting. Modifier 59 may be used when multiple grafts are performed on different sites during the same encounter.

National Reimbursement Benchmarks

National mean rates for CPT code 15100 show that Medicare reimburses at $948.06, while the average commercial rate (BUCA) is higher at $1,010.24. Among individual commercial payers, UnitedHealth Group has the highest mean rate at $1,378.79, and Aetna the lowest at $731.70.

Rate dispersion, measured by the difference between the 75th and 25th percentiles, varies significantly across payers. Medicare has the tightest range ($99.00), indicating more consistent rates, while UnitedHealth Group exhibits the widest range ($830.83), reflecting greater variability. Cigna and Blue Cross Blue Shield also show substantial dispersion, with ranges of $748.00 and $449.92, respectively.

The table and chart below present the full breakdown of national benchmarks for each payer, including mean rates and percentile values.

State Benchmarks

State: AK1 / 50

Alaska Benchmarks

Alaska's reimbursement rates for CPT code 15100 are notably higher than national averages across all major payers. The mean rates for commercial payers such as Aetna, Blue Cross Blue Shield, Cigna, UnitedHealth Group, and BUCA are substantially above their respective national benchmarks, with Aetna's mean rate in Alaska exceeding the national mean by over $2,600. Medicare's mean rate in Alaska is slightly below the national average, but still within a comparable range.

The rate spread, calculated as the difference between the 75th and 25th percentiles, highlights significant variability among payers. Blue Cross Blue Shield exhibits the widest spread at $1,292.49, indicating a broad range of reimbursement rates within the state. In contrast, Aetna's rates are tightly clustered, with all percentiles at $3,778. The table and chart below present the full breakdown of payer-specific rates in Alaska.

Key Insights for Alaska

Aetna is the highest paying payer for CPT 15100 in Alaska, with a mean rate of $3,371.35, while Medicare is the lowest at $921.56.
All commercial payers in Alaska reimburse significantly above their respective national averages, with Aetna's mean rate more than four times the national mean.
The rate spread is widest for Blue Cross Blue Shield, with a difference of $1,292.49 between the 75th and 25th percentiles, indicating substantial variability in reimbursement.

Related Codes

16020

CPT 16020: Dressings/Debridement for Partial-Thickness Burns

15102

CPT 15102: Skin Substitute Graft Application, Trunk/Arms/Legs

15109

CPT 15109: Skin Substitute Graft Application, Trunk/Arms/Legs

15101

CPT 15101: Split-Thickness Autograft, Each Additional 100 sq. cm. or Less

15111

CPT 15111: Epidermal Autograft for Trunk, Arms, or Legs

15119

CPT 15119: Epidermal Autograft, Additional 1% Body Area

16033

CPT 16033: Escharotomy, Each Additional Incision

16023

CPT 16023: Debridement for Small Wounds or Burns

16036

CPT 16036: Escharotomy, each additional incision

15103

CPT 15103: Extension of Recipient Site Preparation for Skin Graft

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National Reimbursement Benchmarks

The table and chart below present the full breakdown of national benchmarks for each payer, including mean rates and percentile values.

National Mean Rates for CPT Code `15100` by Payer

State Benchmarks

State: AK1 / 50

Alaska Benchmarks

Mean Reimbursement Rates by Payer in Alaska for CPT 15100

Key Insights for Alaska

Aetna is the highest paying payer for CPT 15100 in Alaska, with a mean rate of $3,371.35, while Medicare is the lowest at $921.56.
All commercial payers in Alaska reimburse significantly above their respective national averages, with Aetna's mean rate more than four times the national mean.
The rate spread is widest for Blue Cross Blue Shield, with a difference of $1,292.49 between the 75th and 25th percentiles, indicating substantial variability in reimbursement.