CPT 16030 Reimbursement Benchmarks & Policy | OpenPayer

Summary & Overview

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

CPT code 16030 represents the clinical service of dressings and/or debridement for partial-thickness burns covering a large area—more than one extremity or over 10% of the total body surface area. This procedure is a critical component of burn management, addressing the needs of patients with significant injuries to promote healing and prevent complications. Nationally, this code is recognized across major payers, including Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare, reflecting its importance in both outpatient and office-based care settings.

This publication provides a comprehensive overview of 16030, including payer coverage, typical sites of service, and its role within the broader context of burn treatment procedures. Readers will gain insights into clinical benchmarks, policy updates, and the procedural landscape for large-area burn care. The analysis also highlights related codes for smaller burn areas, offering context for how 16030 fits within the spectrum of burn management services. Key modifiers and associated provider taxonomies are discussed to clarify billing and clinical documentation requirements. The summary is designed to inform healthcare professionals, policy analysts, and billing specialists about the national relevance and operational details of this CPT code.

AetnaBlue Cross Blue ShieldCigna HealthMedicareUnitedHealthcareCPT 16030burn carepartial-thickness burnssurgeryintegumentary systemoffice proceduresoutpatient hospitalmedical billingclinical benchmarkspolicy updates

CPT Code Overview

CPT code 16030 is used to report dressings and/or debridement procedures for partial-thickness burns involving a large area—defined as more than one extremity or greater than 10% of the total body surface area. This code falls under the Surgery—Integumentary System service type and is typically performed in an office setting (Place of Service 11) or an outpatient hospital (Place of Service 19/22). The procedure is essential for managing significant burn injuries, ensuring proper wound care and promoting healing in patients with extensive partial-thickness burns.

Clinical & Coding Specifications

Clinical Context

A patient presents to the office or outpatient hospital with partial-thickness burns covering more than one extremity or greater than 10% of their total body surface area. The burns may be the result of an accident, exposure to heat, chemicals, or electricity. The clinical workflow involves assessment of the burn severity, cleaning the affected areas, and performing dressings and/or debridement as needed. This procedure may be performed initially or during subsequent visits, depending on the healing progress and clinical need. The service is typically provided by a physician specializing in surgery, plastic surgery, or surgical critical care.

Coding Specifications

Modifiers:
- Modifier 58: Staged or Related Procedure or Service by the Same Physician During the Postoperative Period. Used when a subsequent procedure is planned or required during the postoperative period of the initial burn treatment.
- Modifier 59: Distinct Procedural Service. Used when a burn dressing or debridement is performed as a separate and distinct service from other procedures on the same day.
Provider Taxonomies:

Taxonomy Code Specialty Name

National Reimbursement Benchmarks

Medicare's national mean rate for CPT code 16030 is $219.90, closely aligned with the BUCA (average commercial) mean rate of $219.61. Among commercial payers, UnitedHealth Group has the highest mean rate at $288.79, while Aetna is the lowest at $152.02.

Rate dispersion, measured by the difference between the 75th and 25th percentiles, varies significantly across payers. Medicare shows the tightest range at $23.00, indicating relatively consistent reimbursement. In contrast, UnitedHealth Group exhibits the widest range at $174.33, reflecting greater variability in rates. Cigna and BCBS also display substantial dispersion, with ranges of $156.80 and $86.83, respectively.

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

State Benchmarks

State: Alaska1 / 50

Alaska Benchmarks

Alaska's reimbursement rates for CPT code 16030 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 leading at $689.96. Medicare's mean rate in Alaska, at $213.42, is close to the national Medicare average, but still slightly below the commercial payers in the state.

The rate spread, calculated as the difference between the 75th and 25th percentiles, varies by payer. Aetna shows no spread, with all percentiles at $781.50, indicating uniformity in rates. Blue Cross Blue Shield and BUCA exhibit larger spreads, suggesting more variability in commercial reimbursement. The table and chart below present the full breakdown of payer rates in Alaska for CPT code 16030.

Key Insights for Alaska

Aetna is the highest paying payer for CPT 16030 in Alaska, with a mean rate of $689.96, while Medicare is the lowest at $213.42.
All commercial payers in Alaska reimburse significantly above their respective national averages for this code.
The rate spread is largest for Aetna (P75-P25 = $0.00, due to identical percentiles), and smallest for Medicare ($20.00), indicating limited variability for Medicare compared to commercial payers.

CPT 16036: Escharotomy, each additional incision

16035-ESCHAROTOMY-INITIAL

CPT 16035: Escharotomy, Initial Incision for Severe Burn Treatment

16025-DRESSINGS-ANDOR-DEBRIDEMENT-OF-PARTIALTHICKNESS-BURNS

CPT 16025: Dressings and Debridement for Medium Partial-Thickness Burns

CPT-16000-FIRST-DEGREE-BURN-WASH-AND-DRESS

CPT 16000: First-Degree Burn Wash and Dressing

16020-DRESSINGS-ANDOR-DEBRIDEMENT-OF-PARTIALTHICKNESS-BURNS

CPT 16020: Dressings/Debridement for Partial-Thickness Burns

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.

National Reimbursement Benchmarks

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

National Mean Rates for CPT Code 16030 by Payer

State Benchmarks

State: Alaska1 / 50

Alaska Benchmarks

Mean Reimbursement Rates by Payer for CPT 16030 in Alaska

Key Insights for Alaska

Aetna is the highest paying payer for CPT 16030 in Alaska, with a mean rate of $689.96, while Medicare is the lowest at $213.42.
All commercial payers in Alaska reimburse significantly above their respective national averages for this code.
The rate spread is largest for Aetna (P75-P25 = $0.00, due to identical percentiles), and smallest for Medicare ($20.00), indicating limited variability for Medicare compared to commercial payers.

CPT 16036: Escharotomy, each additional incision

16035-ESCHAROTOMY-INITIAL

CPT 16035: Escharotomy, Initial Incision for Severe Burn Treatment

16025-DRESSINGS-ANDOR-DEBRIDEMENT-OF-PARTIALTHICKNESS-BURNS

CPT 16025: Dressings and Debridement for Medium Partial-Thickness Burns

CPT-16000-FIRST-DEGREE-BURN-WASH-AND-DRESS

CPT 16000: First-Degree Burn Wash and Dressing

16020-DRESSINGS-ANDOR-DEBRIDEMENT-OF-PARTIALTHICKNESS-BURNS

CPT 16020: Dressings/Debridement for Partial-Thickness Burns

`208600000X`	Surgery Physician
`208800000X`	Plastic Surgery Physician
`2086S0122X`	Surgical Critical Care Physician

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Summary & Overview

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

CPT Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

National Reimbursement Benchmarks

State Benchmarks

Alaska Benchmarks

Key Insights for Alaska

Related Codes

Related Diagnoses

Related CPT Codes

National Reimbursement Benchmarks

State Benchmarks

Alaska Benchmarks

Key Insights for Alaska

Related Codes