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CPT 15116: Epidermal Autograft for Face, Hands, Feet, and Multiple Digits
Headline: CPT code 15116 covers additional epidermal autograft area for complex anatomical sites
CPT code 15116 denotes an epidermal autograft applied to anatomically sensitive areas — including the face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and multiple digits — and is used to bill for each additional 100 cm2 (or additional 1% BSA in pediatric patients). This coding element matters nationally because it affects reimbursement for staged or extensive grafting procedures and for reconstruction involving cosmetically and functionally critical sites.
Key payers covered in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, United Healthcare, and Medicare. Readers will find an overview of the code’s clinical context, its relationship to the initial-unit code 15115, and practical guidance on where the service is typically provided. The publication outlines how payers classify the service, common billing practices for additional graft area, and typical use cases such as treatment of complex wounds, burns, and soft-tissue defects.
This summary prepares clinicians, coding professionals, and revenue-cycle staff to understand when 15116 is used, how it complements the primary graft code, and what to expect across major national payers regarding coverage and billing treatment. Data not available in the input will be noted explicitly in relevant sections.
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Billing Code Overview
CPT code 15116 describes an epidermal autograft procedure for reconstruction of the face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits. The code represents an additional graft unit, billed for each additional 100 cm2 of grafted area in adults or each additional one percent of body surface area in infants and children. This procedure is reported separately from the primary procedure.
Service type: Surgical skin graft (epidermal autograft)
Typical site of service: Operative settings including ambulatory surgery centers and hospital operating rooms; procedures involving facial, cranial, periorbital, oral, neck, genital, hand, foot, and digit anatomical sites.
National Reimbursement Benchmarks
Medicare's mean rate of $167.20 sits well below BUCA's average commercial mean of $460.10, indicating a substantial gap between federal reimbursement and this commercial benchmark. That spread of $292.90 highlights how commercial contracts can diverge from Medicare levels, with BUCA roughly 2.75 times Medicare on average for CPT 15116.
Evaluating dispersion (P75 minus P25) highlights variation across payers: Blue Cross Blue Shield has the widest interquartile spread at $554.30 ($895.80 - $390.50), followed by BUCA at $337.30 ($626.70 - $289.40) and UnitedHealth Group at $163.50 ($332.00 - $168.50). The tightest distributions are Aetna at $34.00 ($166.00 - $132.00) and Cigna at $142.70 ($305.80 - $163.10). Medicare's quartiles are tight at $13.00 ($173 - $160).