CPT 15107: Skin Substitute Graft Application to Trunk/Extremities - OpenPayer

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Summary & Overview

CPT 15107: Skin Substitute Graft Application to Trunk/Extremities

CPT 15107 represents the surgical application of a skin substitute graft to the trunk, arms, or legs, limited to the first 25 square centimeters of a wound when total wound surface area does not exceed 100 square centimeters. This procedure code is relevant for wound management, reconstructive and plastic surgery, and care of complex ulcers and surgical wound complications. Nationally, skin substitute grafting is an important component of limb-sparing and wound-healing strategies, influencing care pathways, facility utilization, and coding practices across outpatient hospital settings. Key payers discussed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare. Readers will find a concise policy and billing overview, comparisons to related CPT codes for larger or different anatomic sites, and clinical context relevant to wound types commonly treated with skin substitutes. The publication outlines typical sites of service and service line placement, highlights common billing modifiers, and identifies associated clinical diagnoses used to support medical necessity. Benchmarks around code usage, payer coverage nuances, and documentation considerations are described to inform coding accuracy and claim submission. Data not available in the input is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareBUCAMedicareCPT15107SkinSubstituteWoundCareSurgeryOutpatientHospitalGraftApplicationPlasticSurgeryBilling

CPT Code Overview

CPT 15107 describes the application of a skin substitute graft to the trunk, arms, or legs for a total wound surface area up to 100 square centimeters, covering the first 25 square centimeters or less of wound surface area. The procedure falls under Surgery and is typically performed in an Outpatient Hospital (POS 22) setting. This code captures the initial application of a skin substitute graft for specified anatomic regions and a defined small wound surface area.

Clinical & Coding Specifications

Clinical Context

A 62-year-old patient with a chronic non-healing lower extremity ulcer presents to an outpatient hospital wound care clinic. The wound measures 20 sq cm on the left lower leg after prior surgical debridement and appropriate conservative care. The surgical team prepares the recipient site, confirms hemostasis, and applies a biologic skin substitute graft to the trunk/arm/leg wound bed in an ambulatory operative suite. Post-application the patient is observed in recovery and discharged with wound care instructions and a plan for scheduled follow-up visits to assess graft take and wound healing.

Coding Specifications

Modifiers
59 (Distinct Procedural Service): Use when the application of the skin substitute graft is a distinct service from other procedures performed on the same date, and documentation supports separate, independent procedures.
76 (Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional): Use when the same procedure (15107) is repeated by the same clinician or other qualified provider during the same day for a separate, distinct wound or a repeat application documented as necessary.
Associated Provider Taxonomies

Taxonomy Code

National Reimbursement Benchmarks

National mean rates for CPT 15107 show parity between Blue Cross Blue Shield and BUCA (the representative commercial benchmark), both at $80.02. Medicare is not present in the provided input, so a direct Medicare comparison is not available. The table and chart below present the full breakdown of available national payer rates.

Rate dispersion across available payers is extremely tight for the reported entries: both BCBS and BUCA have 25th, 50th, and 75th percentiles at $80.00, resulting in a P75–P25 range of $0.00. For other common payers (Aetna, Cigna, UnitedHealth Group, Medicare) the input does not include numeric values, so dispersion cannot be assessed for those payers. The table and chart below present the full breakdown.

State Benchmarks

State: AK1 / 46

Alaska Benchmarks

For CPT code 15107, reimbursement rates in Alaska are highly consistent across Blue Cross Blue Shield and BUCA, with both payers reporting a mean rate of $80.82. The rate spread, calculated as the difference between the 75th and 25th percentiles, is $0.00, indicating no variation in payment amounts among the reported payers. This uniformity is notable and suggests a standardized approach to reimbursement for this procedure in Alaska.

Compared to national averages, Alaska's mean rates are slightly higher for CPT code 15107. The table and chart below present the full breakdown of payer-specific rates in Alaska, highlighting the lack of variability and the alignment between the two major payers.

Key Insights for Alaska

Blue Cross Blue Shield and BUCA both reimburse at $80.82, with no variation between payers for CPT 15107 in Alaska.
The rate spread is $0.00, indicating uniformity across all reported payers.
Alaska's mean rates are slightly higher than national averages for CPT 15107.

Related Codes

15110

CPT 15110: Epidermal Autograft for Trunk, Arms, or Legs

16023

CPT 16023: Debridement for Small Wounds or Burns

16034

CPT 16034: Escharotomy, each additional incision

15112

CPT 15112: Skin Allograft Application, Additional 100 sq cm

16028

CPT 16028: Dressings and Debridement for Small Partial-Thickness Burns

16027

CPT 16027: Escharotomy, Each Additional Incision

16030

CPT 16030: Dressings and Debridement for Large Partial-Thickness Burns

15114

CPT 15114: Split-Thickness Autograft Application, Additional 100 sq cm

15104

CPT 15104: Split-Thickness Autograft for Trunk, Arms, Legs

15003

CPT 15003: Surgical Preparation for Additional Skin Graft Site

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