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    v1.0.30
    OpenPayerBilling CodesSurgical Preparation or Incisional Release of Scar ContractureCPT cpt-15004-skin-graft-recipient-site-preparation
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    CPT 15004: Recipient Site Preparation for Skin Graft

    Medicare pays $417 and commercial payers pay $663 on average nationally for this procedure.

    CPT code 15004 describes surgical preparation of the skin of a body part with an open wound, burn eschar, or scar contracture to receive a skin graft; this procedure is used to ready recipient sites on areas such as the face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, or multiple digits and is reported for the first 100 cm2 in adults and children 10 and older or the first 1% of body area for infants and children under 10. Service type: surgical recipient site preparation for skin grafting. Typical site of service: operating room, procedure suite, or surgical clinic where debridement, excision, or release of scar contracture is performed prior to graft placement.

    For related coverage guidance, see recent payer policy updates: Mohs Micrographic Surgery, Mohs Micrographic Surgery, Mohs Micrographic Surgery.

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    National Reimbursement Benchmarks

    Medicare's national mean of $416.90 sits slightly below BUCA’s average commercial mean of $662.70, indicating that BUCA reimbursements are substantially higher than Medicare for CPT 15004 on a national basis. That gap of $245.80 highlights a meaningful commercial premium versus the government rate; stakeholders comparing payers should note the scale of difference rather than individual plan minutiae.

    Dispersion measured as the interquartile range (P75 minus P25) varies across payers: Blue Cross Blue Shield shows the widest IQR at $556.80 ($978.50 - $542.70), followed by UnitedHealth Group at $359.20 ($732.90 - $370.00) and BUCA at $379.00 ($826.00 - $447.00). Cigna’s IQR is $291.30 ($649.10 - $319.80) and Aetna’s is $174.30 ($485.80 - $268.50), making Aetna the tightest among these payers.

    National Payer Mean Reimbursement Rates

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    State Reimbursement Rates

    State: Alaska1 / 51

    Rate by payer

    Clinical & Coding Specifications

    Clinical Context

    A 34-year-old patient presents to a plastic surgery clinic with a 6-week-old deep partial-thickness burn to the left shoulder and upper arm from a thermal injury. After initial wound care and debridement, the wound base has healthy granulation but requires preparation to receive an autologous split-thickness skin graft. The provider prepares the recipient site by excising residual burn eschar and scar contracture, and refreshes wound margins to create a vascularized bed sized under 100 cm2. Procedure documentation includes preoperative consent, description of anesthesia (local with monitored sedation), measurement of the recipient area, debridement technique, hemostasis, and dressing application. Postoperative workflow documents graft harvest site plan (if performed in same setting), graft placement (if performed), or planned staged grafting. Typical sites for this procedure include the face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, or multiple digits. The typical site of service is an outpatient surgical center or hospital outpatient department; inpatient settings are used for complex or extensive burn cases. Common payors include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare. The expected documentation links the procedure to diagnosis codes such as T22.299A, T24.099A, T31.0, L90.5, or L91.0 to justify medical necessity and to indicate size (first 100 cm2 or first 1% BSA for children under 10) for appropriate billing of 15004.

    Related CPT Codes

    CPT Code

    Related Modifiers

    8 rows

    ModifierDescriptionWhen to Use
    26Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    59Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    66Modifier 66 (Surgical Team) is used when three or more surgeons act as primary surgeons on a single, highly complex procedure. The AMA defines it for use when a surgical team — often composed of…- Use modifier 66 when three or more surgeons act as primary surgeons working collaboratively as a surgical team on a single, highly complex or difficult procedure (for example organ…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
    79Modifier 79 indicates a surgical procedure performed during the postoperative global period of a prior surgery that is unrelated to the original procedure. Per AMA/CPT and CMS guidance, it is…- Use modifier 79 when the same physician (or same‑specialty physician in the same group) performs a surgical procedure during the postoperative global period of a prior surgery and the new procedure…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207YX0007X
    207SG0202X
    152WL0500X
    261QH0700X
    207KA0200X
    261QI0500X
    281PC2000X
    287300000X

    Related Payer Policy Updates

    Specialty: Dermatology1 / 3

    10 rows

    PolicyPayerEffective Date
    Mohs Micrographic Surgerypremerabluecrossofwashington2027-02-05
    Mohs Micrographic Surgerypremerabluecrossofwashington2027-02-05
    Mohs Micrographic Surgerypremerabluecrossofwashington2027-02-05
    FilsuvezCigna2026-11-01
    Destruction of Pre-Malignant Skin LesionsAnthem2026-10-01
    Onychomycosis diagnostic testing and coverageOscar Health2026-10-01
    Treatment of Capillary Malformations (Port Wine Stains)universityofutahhealthplans2026-09-28
    AnzupgoCigna2026-09-15
    Hyperhidrosispriority_health_medicare2026-09-01
    Zevaskyn Coverage for Recessive Dystrophic Epidermolysis BullosaCigna2026-09-01

    Related Codes

    CPT-15002-RECIPIENT-SITE-PREPARATION-SKIN-GRAFT

    CPT 15002: Preparation of Recipient Site for Skin Graft, Trunk/Extremities

    CPT-15003-SKIN-GRAFT-PREPARATION-ADDITIONAL-100CM2

    CPT 15003: Additional Preparation for Skin Graft on Trunk/Extremities

    CPT-15005-SKIN-GRAFT-SITE-EXTENSION-PREPARATION

    CPT 15005: Extended Preparation for Skin Graft (Additional 100 cm2)

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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    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.

    Description
    Relationship to This Procedure
    15005Surgical preparation or creation of recipient site by excision of open wounds, burn eschar, or scar (including subcutaneous tissues), or incisional release of scar contracture; each additional 100 sq cm or each additional 1% of body area of infants and children (list separately in addition to code for primary procedure).Billed in addition to 15004 when recipient site preparation exceeds the first 100 cm2 (or first 1% BSA for children under 10); functions as the add-on for additional area