Summary & Overview
CPT 15105: Split-Thickness Autograft for Face, Scalp, Neck, or Ears
CPT code 15105 represents a split-thickness autograft procedure for the face, scalp, eyelids, mouth, neck, or ears, specifically for the first 100 square centimeters or less, or 1% of the body area in infants and children. This surgical intervention is critical for patients with burns, scars, or other skin conditions affecting highly visible and functional regions. The procedure is typically performed in an outpatient hospital setting, reflecting its importance in acute and reconstructive care.
Blue Cross Blue Shield is a key payer covered in this analysis. Readers will gain insight into clinical indications for the use of CPT 15105, including relevant ICD-10 diagnoses such as burns and scar conditions. The publication also covers common billing modifiers, associated provider taxonomies, and related CPT codes for similar grafting procedures. Policy updates and reimbursement benchmarks are discussed to provide a comprehensive overview of how this code is utilized in surgical practice and medical billing.
This summary offers a national perspective on the clinical and administrative aspects of CPT 15105, equipping healthcare professionals, billing specialists, and policy analysts with essential information for understanding its role in patient care and reimbursement.
CPT Code Overview
CPT 15105 describes a split-thickness autograft procedure involving the face, scalp, eyelids, mouth, neck, or ears. This surgical service is performed for the first 100 square centimeters or less, or 1% of the body area in infants and children. The typical site of service for this procedure is an outpatient hospital setting (Place of Service 22). Split-thickness autografts are commonly used to treat burns, scars, and other conditions requiring skin replacement in sensitive or visible areas.
Clinical & Coding Specifications
Clinical Context
A pediatric patient presents to the outpatient hospital with a second-degree burn on the face. The burn has resulted in significant skin loss and requires surgical intervention. The clinical workflow involves assessment by a plastic surgeon or dermatologist, preparation of the recipient site, and harvesting a split-thickness skin autograft from a donor site. The graft is then applied to the affected area (face, scalp, eyelids, mouth, neck, or ears) covering up to 100 sq cm or 1% of the body area. Postoperative care includes monitoring for graft viability and healing.
Coding Specifications
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Modifier
51(Multiple Procedures):- Used when more than one surgical procedure is performed during the same session. Indicates that
CPT code 15105is one of several procedures.
- Used when more than one surgical procedure is performed during the same session. Indicates that
-
Modifier
59(Distinct Procedural Service):- Used to identify procedures/services that are not normally reported together, but are appropriate under the circumstances. Applied when
CPT code 15105is performed separately from other procedures.
- Used to identify procedures/services that are not normally reported together, but are appropriate under the circumstances. Applied when
| Provider Taxonomy Code | Specialty Name |
|---|---|
208200000X | Plastic Surgery |
207ND0101X | Dermatology |
2086S0122X | Surgical Oncology |
Related Diagnoses
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T20.20XA- Burn of second degree of face, initial encounter- Indicates a recent second-degree burn to the face, commonly necessitating skin grafting procedures such as
15105.
- Indicates a recent second-degree burn to the face, commonly necessitating skin grafting procedures such as
-
L90.5- Scar conditions and fibrosis of skin- Represents chronic scarring or fibrosis, which may require surgical intervention with a skin graft to restore function or appearance.
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T21.31XA- Burn of third degree of chest wall, initial encounter- While not directly related to the face, this diagnosis may be present in patients with multiple burn sites, some of which may require grafting.
-
T22.20XA- Burn of second degree of shoulder and upper limb, initial encounter- Indicates burns on the shoulder and upper limb; relevant if multiple areas are treated during the same session.
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L91.0- Hypertrophic scar- Refers to raised, thickened scars that may be surgically managed with grafting procedures like
15105.
- Refers to raised, thickened scars that may be surgically managed with grafting procedures like
Related CPT Codes
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15100- Split-thickness autograft, trunk, arms, legs; first 100 sq cm or less- Used for autografts on body areas other than the face, scalp, eyelids, mouth, neck, or ears. May be performed in conjunction with
15105if multiple regions require grafting.
- Used for autografts on body areas other than the face, scalp, eyelids, mouth, neck, or ears. May be performed in conjunction with
-
15120- Split-thickness autograft, face, scalp, eyelids, mouth, neck, or ears; each additional 100 sq cm- Used when the grafted area exceeds 100 sq cm. Billed in addition to
15105for larger surface areas.
- Used when the grafted area exceeds 100 sq cm. Billed in addition to
-
15240- Full-thickness graft, free, including direct closure of donor site, face, scalp, eyelids, mouth, neck, ears; first 20 sq cm or less- Alternative to
15105when a full-thickness graft is clinically indicated instead of a split-thickness graft.
- Alternative to
-
15002- Surgical preparation or creation of recipient site by excision of open wounds, burn eschar, or scar- Often performed prior to graft placement. May be billed with
15105if recipient site preparation is required.
- Often performed prior to graft placement. May be billed with
National Reimbursement Benchmarks
Nationally, Blue Cross Blue Shield and BUCA (average commercial) both reimburse CPT code 15105 at a mean rate of $80.02. Medicare data is not available in the input for comparison.
Rate dispersion is minimal across these commercial payers, with the 25th, 50th, and 75th percentiles all at $80.00, indicating a very tight range and little variation in reimbursement rates. No payer shows a wider spread; all are uniform.
The table and chart below present the full breakdown of national mean rates and percentile values for each payer.
State Benchmarks
State: AK1 / 46
Alaska Benchmarks
For CPT code 15105, Alaska's reimbursement rates from Blue Cross Blue Shield and BUCA show no spread, with the 25th, 50th, and 75th percentiles all at $80.00. This indicates a uniform payment structure across providers, as the rate spread (P75 minus P25) is $0.00. Compared to national averages, Alaska's mean rates are marginally higher, but the difference is less than $1.00, suggesting close alignment with broader benchmarks.
The table and chart below present the full payer breakdown for Alaska, highlighting the consistent rates across both Blue Cross Blue Shield and BUCA for CPT code 15105. No other payers have available data for this state.
Key Insights for Alaska
- Blue Cross Blue Shield and BUCA both offer identical mean rates for CPT 15105 in Alaska, with no variation between payers.
- The highest and lowest paying payers are tied, both at $80.82.
- Alaska's mean rates are slightly higher than national averages, but the difference is minimal.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.