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CPT 15738: Lower Extremity Muscle/Myocutaneous/Fasciocutaneous Flap
CPT code 15738 denotes creation of a muscle, myocutaneous, or fasciocutaneous flap from a patient’s lower extremity to repair injuries or close open wounds. This reconstructive procedure is critical for limb salvage, wound coverage, and restoration of function after trauma, infection, or chronic ulceration. Nationally, proper coding for complex flap procedures affects clinical coordination, hospital resource allocation, and payment pathways for surgical teams and facilities.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical indications, typical sites of service, associated procedural groupings, and the common billing relationships between 15738 and nearby flap and wound closure codes. The publication outlines typical documentation elements that support medical necessity for lower-extremity flap reconstruction and highlights common clinical scenarios driving use, such as traumatic open wounds and non-healing ulcers.
The report provides benchmarks and policy context relevant to claims processing and coverage considerations, explains how 15738 relates to other reconstructive CPT codes, and summarizes payer practice patterns where available. Data not available in the input is noted explicitly when applicable.
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Billing Code Overview
CPT code 15738 describes the surgical creation of a muscle, myocutaneous, or fasciocutaneous flap harvested from a lower extremity to treat injury or to close an open wound on an affected area. The procedure involves raising tissue with its vascular supply from the leg to reconstruct soft-tissue defects and promote wound closure.
Service Type: Reconstructive soft-tissue flap surgery
Typical Site of Service: Operating room or surgical suite, inpatient or outpatient hospital setting, depending on wound severity and patient condition.
National Reimbursement Benchmarks
Medicare’s mean rate for CPT 15738 sits at $1,167.20, which is roughly half of BUCA’s average commercial mean of $2,438.50. This gap highlights a substantial differential between federal reimbursement and a commercial benchmark that aggregates multiple commercial contracts, with BUCA about $1,271.30 higher than Medicare on average.
Dispersion measured by the interquartile range (P75–P25) varies materially across payers. Blue Cross Blue Shield shows the widest IQR at $3,214.20, followed by BUCA at $2,343.70 and Cigna at $1,377.70. The tightest IQRs are Aetna at $1,021.50 and Medicare at $85.00, indicating relatively concentrated commercial reimbursements for Aetna and very consistent Medicare localities.