Summary & Overview
CPT 15115: Epidermal Autograft for Sensitive Areas in Infants and Children
CPT code 15115 is a nationally recognized billing code for epidermal autograft procedures targeting sensitive areas such as the face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and multiple digits. This code is specifically used for the first 100 square centimeters or less, or one percent of the body area in infants and children, reflecting its importance in pediatric and reconstructive surgery. The procedure is typically performed in hospital outpatient or ambulatory surgical center settings, underscoring its role in acute and complex skin replacement cases.
Major payers covering this code include Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare. The publication provides a comprehensive overview of payer coverage, clinical benchmarks, and policy updates relevant to this procedure. Readers will gain insights into the clinical context, typical sites of service, and the scope of conditions commonly treated with this autograft technique. The summary also highlights related codes and modifiers, offering a clear understanding of billing nuances and procedural distinctions. This resource is designed to inform healthcare professionals, administrators, and policy analysts about the national landscape for CPT code 15115, supporting informed decision-making in medical billing and reimbursement.
CPT Code Overview
CPT code 15115 describes an epidermal autograft procedure for the replacement of skin on sensitive and critical areas, including the face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and multiple digits. This code applies to the first 100 square centimeters or less, or one percent of the body area in infants and children. The service is classified as a surgical procedure—skin replacement/autograft, typically performed in a hospital outpatient or ambulatory surgical center setting.
Clinical & Coding Specifications
Clinical Context
A typical patient scenario involves a child or adult presenting with a third-degree burn, scar, or open wound affecting sensitive areas such as the face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, or multiple digits. The patient requires surgical intervention for skin replacement using an epidermal autograft. The procedure is performed in a hospital outpatient or ambulatory surgical center setting. The clinical workflow includes assessment of the wound or burn, preparation of the recipient site, harvesting of the epidermal graft from a donor site, and placement of the graft to restore skin integrity and function in the affected area.
Coding Specifications
-
Modifier
59: Used to indicate a distinct procedural service, when the procedure is performed separately from other services during the same encounter. -
Modifier
76: Used when the same procedure is repeated by the same physician or other qualified healthcare professional.
| Taxonomy Code | Specialty |
|---|---|
208200000X | Plastic Surgery |
207X00000X | Dermatology |
208600000X | Surgery |
Related Diagnoses
-
L90.5: Scar conditions and fibrosis of skin- Indicates the presence of scarring or fibrotic changes requiring skin replacement.
-
T20.30XA: Burn of third degree of head, face, and neck, unspecified site, initial encounter- Represents severe burns in sensitive areas, often necessitating autograft procedures.
-
S01.90XA: Unspecified open wound of unspecified part of head, initial encounter- Covers open wounds in the head region that may require skin grafting for closure and healing.
-
L98.9: Disorder of the skin and subcutaneous tissue, unspecified- Used for unspecified skin disorders that may warrant surgical intervention with autografting.
-
T21.31XA: Burn of third degree of chest wall, initial encounter- Indicates severe burns of the chest wall, which may be treated with autograft procedures, though not the primary area for
15115.
- Indicates severe burns of the chest wall, which may be treated with autograft procedures, though not the primary area for
Related CPT Codes
-
15116: Epidermal autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; each additional 100 sq cm or one percent of body area of infants and children.- Used in conjunction with
15115when the grafted area exceeds the first 100 sq cm or 1% of body area.
- Used in conjunction with
-
15100: Split-thickness autograft, trunk, arms, legs; first 100 sq cm or less, or 1% of body area of infants and children.- Alternative for autografting procedures on trunk, arms, or legs rather than the sensitive areas covered by
15115.
- Alternative for autografting procedures on trunk, arms, or legs rather than the sensitive areas covered by
-
15120: Split-thickness autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits.- Alternative or companion code for split-thickness autografts in the same sensitive areas as
15115.
- Alternative or companion code for split-thickness autografts in the same sensitive areas as
National Reimbursement Benchmarks
UnitedHealth Group has the highest national mean rate for CPT code 15115 at $1,305.02, while Medicare's mean rate is $884.26. The average commercial benchmark (BUCA) stands at $1,025.43, which is $141.17 higher than Medicare. Blue Cross Blue Shield and Aetna have mean rates of $939.54 and $811.96, respectively, with Cigna at $1,212.44.
Rate dispersion varies significantly across payers. Medicare shows the tightest range between the 25th and 75th percentiles ($82.00), indicating less variability in reimbursement. In contrast, UnitedHealth Group and Cigna exhibit the widest dispersions ($764.67 and $696.50, respectively), reflecting greater variability in commercial rates. The table and chart below present the full breakdown of national benchmarks for each payer.
State Benchmarks
State: AK1 / 50
Alaska Benchmarks
Alaska exhibits a wide spread in reimbursement rates for CPT code 15115, with the highest payer (Aetna) offering a mean rate of $3,271.09 and the lowest (Medicare) at $862.88. The rate spread, calculated as the difference between the 75th and 25th percentiles, is most pronounced for Blue Cross Blue Shield ($1,266.40) and BUCA ($1,211.77), indicating substantial variability in commercial payer rates. In contrast, Medicare's spread is much narrower at $73.00, reflecting more consistent government reimbursement.
Compared to national averages, Alaska's commercial payers consistently reimburse at much higher rates, with Aetna's mean rate nearly four times the national mean. The table and chart below present the full breakdown of payer-specific rates and percentiles for Alaska, highlighting the state's unique reimbursement landscape.
Key Insights for Alaska
- Aetna is the highest paying payer for CPT 15115 in Alaska, with a mean rate of $3,271.09.
- Medicare is the lowest paying payer, with a mean rate of $862.88.
- All commercial payers in Alaska reimburse at rates significantly above their respective national averages, with Aetna's mean rate nearly four times the national mean.
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.