CPT 15114 Reimbursement Benchmarks & Policy | OpenPayer

Summary & Overview

CPT 15114: Split-Thickness Autograft Application, Additional 100 sq cm

CPT code 15114 is a surgical billing code for the application of split-thickness autografts to the face, scalp, eyelids, mouth, neck, ears, orbits, covering each additional 100 sq cm or part thereof. This procedure is critical for patients with burns, wounds, or skin disorders affecting these sensitive areas, and is typically performed in outpatient hospital settings. The code is used in conjunction with primary autograft application codes to account for larger treatment areas.

Blue Cross Blue Shield is a key payer included in this analysis. The publication provides an overview of clinical indications, typical sites of service, and relevant coding practices. Readers will gain insight into national benchmarks, policy updates, and clinical context for the use of 15114, including its relationship to primary and related CPT codes. The summary also covers common modifiers and associated taxonomies, offering a comprehensive view of how this code is utilized in surgical and dermatological practice. This information is essential for understanding reimbursement, compliance, and coding accuracy for split-thickness autograft procedures.

Blue Cross Blue ShieldCPT 15114split-thickness autograftsurgeryoutpatient hospitalplastic surgerydermatologyburn treatmentwound caremedical billingprocedure coding

CPT Code Overview

CPT code 15114 describes the application of a split-thickness autograft to the face, scalp, eyelids, mouth, neck, ears, orbits for areas of 100 sq cm or less, specifically for each additional 100 sq cm or part thereof. This procedure is classified under surgery and is commonly performed in an outpatient hospital setting (Place of Service 22). Split-thickness autografts are used to treat complex wounds, burns, and other conditions requiring skin replacement, providing essential coverage and promoting healing in sensitive anatomical regions.

Clinical & Coding Specifications

Clinical Context

A patient presents to the outpatient hospital with a third-degree burn or significant scar tissue involving the face, scalp, eyelids, mouth, neck, ears, or orbits. After initial wound management and surgical preparation of the recipient site, the provider applies a split-thickness autograft to cover an area greater than 100 sq cm. The procedure is performed by a specialist in plastic surgery, dermatology, or general surgery. The workflow includes assessment, excision of nonviable tissue, preparation of the recipient site, harvesting of the autograft, and application to the affected area. Additional increments of 100 sq cm or part thereof are coded separately using 15114 in addition to the primary procedure code.

Coding Specifications

Modifier 51 (Multiple Procedures):
- Used when more than one surgical procedure is performed during the same session by the same provider.
Modifier 59 (Distinct Procedural Service):
- Used to indicate that a procedure or service is distinct or independent from other services performed on the same day.

Taxonomy Code	Specialty

National Reimbursement Benchmarks

Blue Cross Blue Shield and BUCA (average commercial) both report a national mean rate of $80.02 for CPT code 15114. Medicare data is not available in the input, so a comparison between commercial and Medicare rates cannot be made.

Rate dispersion is minimal across both commercial payers, with the 25th, 50th, and 75th percentiles all at $80.00. This indicates a very tight range, with no significant variation in reimbursement rates nationally for this code. The table and chart below present the full breakdown of national benchmarks by payer.

State Benchmarks

State: Alaska1 / 46

Alaska Benchmarks

For CPT code 15114, reimbursement rates in Alaska are highly consistent across Blue Cross Blue Shield and BUCA, with all percentile values—25th, 50th, and 75th—equal to $80.00. This results in a rate spread of $0.00, indicating no variation in payment amounts among these payers. Such uniformity is uncommon and suggests standardized pricing for this procedure in the state.

Compared to national averages, Alaska's mean rates are slightly higher, with both Blue Cross Blue Shield and BUCA averaging $80.82 versus the national mean of $80.02. The table and chart below present the full payer breakdown for Alaska, highlighting the lack of rate variation and the state's position relative to national benchmarks.

Key Insights for Alaska

Blue Cross Blue Shield and BUCA both reimburse at $80.82, representing the highest and lowest rates in Alaska for CPT 15114.
There is no rate spread in Alaska; all percentiles are identical, indicating uniform reimbursement across payers.
Alaska's mean rates are slightly higher than national averages for CPT 15114.

16034 – Escharotomy; each additional incision (List separately in addition to code for primary procedure)

15104-SPLITTHICKNESS-AUTOGRAFT-TRUNK-ARMS-LEGS-FIRST-100-SQ-CM-OR

15104 – Split-thickness autograft, trunk, arms, legs; first 100 sq cm or less, or 1% of body area of infants and children

15103-AT-THE-SAME-ENCOUNTER-THAT-THE-PROVIDER-PREPARES-100CM2-OF

15103 – At the same encounter that the provider prepares 100 cm2 of a body part with an open wound, burn eschar, or scar contracture to receive a skin graft, he extends the site up to an additional 100 cm2. This procedure helps in repairing areas of the trunk, arms, or legs. In children under 10, this code applies to each additional 1 percent of body area after the first.

15118-APPLICATION-OF-SKIN-SUBSTITUTE-GRAFT-TO-FACE-SCALP-EYELIDS

15118 – Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; total wound surface area up to 100 sq cm, each additional 1 sq cm, or part thereof (List separately in addition to code for primary procedure)

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

16020 – Dressings and/or debridement of partial‑thickness burns, initial or subsequent

15107-APPLICATION-OF-SKIN-SUBSTITUTE-GRAFT-TO-TRUNK-ARMS-LEGS

15107 – Application of skin substitute graft to trunk, arms, legs, total wound surface area up to 100 sq cm; first 25 sq cm or less wound surface area

15101-EACH-ADDITIONAL-100-SQ-CM-OR-LESSAFTER-PRIMARY-PROCEDURE-OF

CPT 15101: Split-Thickness Autograft, Each Additional 100 sq. cm. or Less

16028-DRESSINGS-ANDOR-DEBRIDEMENT-OF-PARTIALTHICKNESS-BURNS

CPT 16028: Dressings and Debridement for Small Partial-Thickness Burns

15002-SURGICAL-PREPARATION-OR-INCISIONAL-RELEASE-OF-SCAR

CPT 15002: Surgical Preparation or Incisional Release of Scar Contracture

16032-DRESSINGS-ANDOR-DEBRIDEMENT-OF-PARTIALTHICKNESS-BURNS

CPT 16032: Dressings and Debridement for Small Partial-Thickness Burns

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`208200000X`	Plastic Surgery
`207N00000X`	Dermatology
`208600000X`	Surgery

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Summary & Overview

CPT 15114: Split-Thickness Autograft Application, Additional 100 sq cm

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