CPT 15574: Direct or Tubed Pedicle Skin Flap for Reconstructive Repair - OpenPayer

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Summary & Overview

CPT 15574: Direct or Tubed Pedicle Skin Flap for Reconstructive Repair

CPT code 15574 covers preparation of a direct or tubed pedicle skin flap harvested from the patient’s healthy skin and tissue to repair wounds or injuries in anatomically specific areas (forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, or feet). This reconstructive surgical code matters nationally because pedicle flap techniques remain essential for restoring form and function after trauma, oncologic resection, or complex soft-tissue loss.

Key payers in the coverage landscape include Aetna, Blue Cross Blue Shield plans, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical indications and typical settings where the service is provided, plus a concise guide to what to expect in payer coverage and billing practice. The publication highlights common procedural contexts for CPT code 15574, outlines typical modifiers used in practice, and identifies areas where documentation and clinical detail commonly affect payment and claims adjudication.

This national-focused summary equips clinicians, practice managers, and billing professionals with the clinical framing and operational context needed to code and document direct or tubed pedicle skin flap procedures appropriately. Data not available in the input for payer-specific reimbursement levels and associated diagnosis codes are noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare15574CPTpedicle skin flapreconstructive surgerysoft tissue reconstructionsurgical codingoperative procedureplastic surgeryambulatory surgical center

Billing Code Overview

CPT code 15574 describes the preparation of a direct or tubed pedicle skin flap using the patient’s own healthy skin and tissue to cover an injury or wound. The provider may transfer the flap to a recipient site or leave it in place attached by a pedicle. This code is specific to procedures performed on the forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, or feet.

Service type: Surgical soft tissue reconstruction using a direct or tubed pedicle skin flap
Typical site of service: Operating room, ambulatory surgical center, or other procedural facility where reconstructive flap surgery is performed

Clinical & Coding Specifications

Clinical Context

A 58-year-old male construction worker presents to the emergency department after a facial avulsion injury from blunt trauma. The defect involves the left cheek and extends into the perioral tissues with exposed subcutaneous fat and partial-thickness loss of skin. After initial resuscitation, wound irrigation, tetanus update, and debridement in the operating room, the reconstructive surgeon plans a direct pedicle skin flap using adjacent healthy forehead/cheek tissue to provide durable coverage and preserve contour and oral function. The procedure is performed in the operating room under general anesthesia with intraoperative assessment of flap perfusion, pedicle design, elevation, inset to the recipient site, and layered closure of donor and recipient areas. Postoperative care includes dressing changes, flap viability checks, antibiotic coverage, and outpatient follow-up for potential pedicle division if a staged transfer is performed. Typical site of service: outpatient surgery center or hospital operating room. Service type: reconstructive/plastic surgery skin flap procedure for coverage of traumatic or surgical soft-tissue defects of the face, neck, axillae, genitalia, hands, or feet.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when work required is substantially greater than usual for this procedure (extensive debridement, complex dissection, prolonged operative time).

CPT 15630: Division and Inset of Pedicled Flap for Facial Structures

15734

CPT 15734: Muscle or Myocutaneous Flap Surgery for Trunk Reconstruction

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CPT 15600: Division of Pedicled Flap and Inset at Trunk

15738

CPT 15738: Muscle or Fasciocutaneous Flap for Lower Extremity

cpt-15610-pedicled-flap-division-and-graft-inset-scalp-arm-leg

CPT 15610: Division of Pedicled Flap and Graft Inset

cpt-15650-pedicle-flap-transfer-reconstructive-surgery

CPT 15650: Pedicle Flap Transfer, Reconstructive Surgery

cpt-15576-pedicle-skin-flap-eyelids-nose-ears-lips-intraoral

CPT 15576: Pedicle Skin Flap for Eyelids, Nose, Ears, Lips, Intraoral

cpt-15736-upper-extremity-flap-reconstruction

CPT 15736: Upper-Extremity Muscle or Fasciocutaneous Flap Reconstruction

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CPT 15730: Zygomaticofacial Flap for Midface/Scalp Wound Coverage

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CPT 15572: Pedicle Skin Flap Preparation for Scalp, Arms, or Legs

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Taxonomy Code	Specialty	Notes
207P00000X	Plastic Surgery	Primary specialty that performs pedicle flap reconstruction of face, hands, feet, and genitalia.
208800000X	Surgical Oncology	May perform reconstructive flaps after tumor resection in head and neck or skin cancers.
208600000X	Otolaryngology (ENT)	Performs facial and head/neck reconstruction, especially perioral and nasal region defects.
207L00000X	Hand Surgery	Fellowship-trained surgeons performing pedicle flaps for hand and finger soft-tissue coverage.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`S01.401A`	Laceration without foreign body of unspecified cheek and TMJ area, initial encounter	Facial lacerations with tissue loss may require pedicle flap coverage for durable reconstruction and contour restoration.
`S41.112A`	Laceration with foreign body of left shoulder, initial encounter	Soft-tissue defects of the axilla/shoulder region with tissue loss may be reconstructed using pedicle flaps to preserve function.
`S81.811A`	Open wound, right ankle, initial encounter	Traumatic wounds of the foot/ankle with soft-tissue exposure may require pedicle flaps for coverage over tendons or bones.
`C44.31`	Squamous cell carcinoma of skin of scalp and neck	Tumor extirpation in head/neck often necessitates pedicle flap reconstruction to close defects and restore form/function.
`D49.2`	Neoplasm of uncertain behavior of skin	Excisional defects from uncertain skin lesions may require flap coverage when primary closure is not possible.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`12001`	Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities; 2.5 cm or less	May be performed for smaller lacerations or as initial wound management prior to flap planning; not a substitute when flap required.
`13160`	Secondary closure of surgical wounds; complicated, extensive	May be used for delayed closure of donor or recipient sites when primary closure is not feasible.
`14040`	Adjacent tissue transfer or rearrangement, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, and/or feet; 25 sq cm or less	Codes for local flap procedures similar in anatomic scope; selection depends on flap type and size — `15574` is specifically a pedicle flap code, while `14040` may describe smaller local flap transfers.
`15730`	Pedicle graft or flap; trunk	Related pedicle flap code for other anatomic regions — used when trunk reconstruction is required instead of regions covered by `15574`.
`13131`	Repair, complex, scalp, arms, hands, feet, legs, and/or trunk; 30.1 cm to 90.0 cm	May be billed for complex layered closure adjacent to flap reconstruction when applicable.

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