Summary & Overview
CPT 14061: Local Tissue Reconstruction for Facial Defects
CPT code 14061 documents a local tissue reconstruction procedure for defects of the eyelids, nose, ears, or lips measuring 10.1 cm2 to 30.0 cm2. This reconstructive code is used to report adjacent tissue transfer techniques that restore form and function after lesion excision, making it relevant to dermatologic surgeons, plastic surgeons, and facilities managing facial soft-tissue defects. Nationally, accurate use of this code affects claims processing, quality measurement for reconstructive services, and appropriate grouping for facility and professional reimbursement.
Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for CPT code 14061, typical sites of service, and the scope of defects represented by the code. The publication also summarizes benchmarks for utilization, common billing considerations, and recent policy updates or payer guidance where available. Clinical notes clarify when this code applies versus alternative reconstructive codes based on defect size and anatomical site. This resource is intended for billing professionals, clinicians, and policy analysts seeking a clear, national-level reference for reporting and reviewing procedures involving adjacent tissue reconstruction of facial structures.
Billing Code Overview
CPT code 14061 describes a reconstructive procedure in which the provider replaces lesions of the eyelids, nose, ears, or lips using tissue transferred from an adjacent site. This code applies when the surgical defect measures 10.1 cm2 to 30.0 cm2.
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Service type: Soft tissue reconstruction / local tissue transfer (adjacent tissue rearrangement)
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Typical site of service: Ambulatory surgery center or hospital outpatient department; may also be performed in an office-based surgical suite depending on facility capabilities and patient needs.
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Clinical & Coding Specifications
Clinical Context
A 67-year-old patient presents to an outpatient dermatologic surgery clinic with a recurrent basal cell carcinoma involving the lateral lower eyelid measuring 3.5 cm by 2.5 cm after excision of the primary tumor. After Mohs micrographic excision and confirmation of clear margins, the resulting full-thickness defect measures 18.0 cm2. The reconstructive surgeon performs a local flap reconstruction using adjacent healthy eyelid and periorbital tissue to close the eyelid defect and restore eyelid margin continuity and ocular protection. The clinical workflow includes preoperative evaluation and informed consent, local or monitored anesthesia care, excision with margin control (if performed during the same visit), flap design and elevation, inset and layered closure, hemostasis, dressing application, and immediate postoperative assessment. Typical documentation includes operative report with defect size (cm2), flap type and donor site, anesthesia type, estimated blood loss, specimens sent (if applicable), and postoperative instructions. Typical sites of service are outpatient dermatologic surgery centers, ambulatory surgical centers, and hospital outpatient departments where reconstructive procedures on the eyelids, nose, ears, or lips are performed.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
59 | Distinct procedural service | Use when another procedure on a separate anatomic site or distinct procedural service is performed the same day and should be reported separately from the flap reconstruction. |
51 | Multiple procedures | Use on secondary procedures when multiple surgeries are performed during the same session and payor requires this modifier for multiple procedure processing. |
53 | Discontinued procedure | Use if the reconstruction was started but aborted due to an unexpected clinical condition. |
22 | Increased procedural services | Use when the work required is substantially greater than typical (extensive dissection, complex reconstruction) with supporting documentation. |
79 | Unrelated procedure/service by the same physician during the postoperative period | Use when a separate, unrelated procedure is performed during the global period. |
24 | Unrelated E/M service during postoperative period | Use when an evaluation unrelated to the surgery occurs during the global period (note: 24 is not in the provided list; therefore not included). |
26 | Professional component | Use if only the surgeon’s professional component is billed separately (rare for global surgical procedures). |
RT | Right side | Use to designate right-sided procedure when laterality is required by payor. |
LT | Left side | Use to designate left-sided procedure when laterality is required by payor. |
50 | Bilateral procedure | Use when the reconstructive procedure is performed bilaterally and payor requires a bilateral modifier. |
22 | Increased procedural services | (Duplicate entry excluded) |
62 | Two surgeons | Use when two surgeons work together as primary surgeons performing distinct portions of the reconstruction. |
66 | Surgical team concept | Use when a surgical team approach is required for complex reconstruction. |
52 | Reduced service | Use when the procedure is partially reduced or not completed as described in the full code description. |
78 | Return to the operating room for a related procedure during the postoperative period | Use when a related return to OR for complications or revision occurs during the global period. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 207P00000X | Dermatology | Dermatologic surgeons commonly perform local flap reconstructions after skin cancer excision. |
| 208000000X | Otolaryngology (ENT) | ENT surgeons perform facial reconstructive flaps on the nose, ears, and periorbital region. |
| 207L00000X | Plastic Surgery | Plastic and reconstructive surgeons commonly perform complex local flap closures and aesthetic reconstruction for defects in this size range. |
| 208500000X | Ophthalmology | Oculoplastic surgeons manage eyelid reconstructions and specialized periocular flap procedures. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
C44.119 | Basal cell carcinoma of skin of left eyelid, including canthus | Common malignant lesion requiring excision with subsequent local flap reconstruction of eyelid defects. |
C44.129 | Basal cell carcinoma of skin of right eyelid, including canthus | As above, right-sided lesion leading to similar reconstructive needs. |
C44.219 | Squamous cell carcinoma of skin of left eyelid, including canthus | Squamous cell carcinomas of periocular skin often require excision and flap closure for functional and cosmetic restoration. |
L98.4 | Non-healing surgical wound | May be relevant for reconstruction of chronic or non-healing defects requiring flap coverage. |
S01.11XA | Laceration without foreign body of right eyelid and periocular area, initial encounter | Traumatic defects sometimes require adjacent tissue transfer for closure of eyelid defects. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
14060 | Adjacent tissue transfer or rearrangement, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, feet, or other sites; defect 10.0 cm2 or less | Used for smaller defects; may be billed instead if the defect size is within this smaller size range. |
14062 | Adjacent tissue transfer or rearrangement, eyelids, nose, ears, or lips; defect 30.1 cm2 to 60.0 cm2 | Used when the defect size exceeds the 10.1–30.0 cm2 range of 14061 and a larger code is appropriate. |
12011 | Simple repair of superficial wounds of face, ears, eyelids, nose, lips; 2.6 cm to 7.5 cm | May be performed for layered closure of smaller defects or donor site closures during the reconstructive procedure. |
13132 | Secondary intermediate repair, face, ears, eyelids, nose, lips; 1.1 cm to 2.5 cm | Used for revision or secondary repairs of wounds if needed during the postoperative period. |
14000 | Adjacent tissue transfer or rearrangement, any area; defect size not specified in eyelids/nose/ears/lips codes | Sometimes used when coding guidance or defect location differs; selection depends on site-specific codes and payor rules. |