Midface flap (ie, zygomaticofacial flap) with preservation of vascular pedicle(s)
Audit Defense & Denial Intelligence
Research-based denial patterns from OrbDoc Bill Analyzer
1. Skin graft size documentation insufficient or recipient site not specified
Common15730 (skin graft midface area, first 25 sq cm or less) requires documented graft size measurement and specific recipient site location. Denied when size not measured/documented, when site not midface anatomically, or when preparation/graft placement technique inadequate. Midface = nose, lips, chin, ears, eyelids, neck, axillae, genitalia, hands, feet.
Common Causes
- • Documentation states 'skin graft applied' without measuring graft dimensions
- • Graft size estimated visually - payers require actual measurement in sq cm
- • Anatomic site not specified - 'facial graft' could be midface or other face codes
Resolution Strategy
Document graft size and technique: 'Nasal tip defect following Mohs excision. Recipient site prepared with sharp debridement to healthy granulation tissue. Full-thickness skin graft harvested from preauricular area, 3.2cm x 2.1cm = 6.7 sq cm. Graft positioned and secured with 6-0 nylon interrupted sutures and bolster dressing applied.' Must specify: anatomic location (nose = midface), measured dimensions, total sq cm calculated, graft technique. If >25 sq cm, add 15731 for each additional 25 sq cm. If site not midface, use appropriate anatomic code (15240 for forehead, etc.). Cannot appeal without documented measurements.
Relative Value Units (RVUs)
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Clinical Information
When to Use
For complex facial reconstruction using midface flap with intact vascular pedicle, typically for significant facial defects
Common Scenarios
Documentation Requirements
- Defect size and location
- Flap design and dimensions
- Vascular pedicle preservation documented
- Donor site closure method
- Operative time and complexity
Coding Guidelines
Common Modifiers
Bundling Rules
- Includes flap design and insetting
- Donor site closure included if primary
- Complex preparation of recipient site included
Exclusions
- Free flaps coded separately with microsurgery codes
- Simple adjacent tissue transfer uses 14000 series
- Skin grafts use different codes
Coding Notes
Clinical scenarios
- Defect size and location
- Flap design and dimensions
- Vascular pedicle preservation documented
- Defect size and location
- Flap design and dimensions
- Vascular pedicle preservation documented
- Defect size and location
- Flap design and dimensions
- Vascular pedicle preservation documented
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Code Details
Medicare Pricing
PFSRVU Breakdown
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Ask a QuestionFrequently Asked Questions
CPT 15730 is the billing code for "Midface flap (ie, zygomaticofacial flap) with preservation of vascular pedicle(s)". For complex facial reconstruction using midface flap with intact vascular pedicle, typically for significant facial defects
Medicare pays approximately $1359.20 for CPT 15730 (national average). Actual payment varies by geographic location due to GPCI adjustments. Hospital and commercial insurance rates are typically 2-4x higher than Medicare rates.
CPT 15730 has a total RVU of 43.17, broken down as: Work RVU 19.45, Practice Expense RVU 21.83, and Malpractice RVU 1.89. RVUs (Relative Value Units) determine Medicare reimbursement rates.
The most common denial reason for CPT 15730 is "Skin graft size documentation insufficient or recipient site not specified". 15730 (skin graft midface area, first 25 sq cm or less) requires documented graft size measurement and specific recipient site location. Denied when size not measured/documented, when site not midface anatomically, or when preparation/graft placement technique inadequate. Midface = nose, lips, chin, ears, eyelids, neck, axillae, genitalia, hands, feet. Common causes include: Documentation states 'skin graft applied' without measuring graft dimensions; Graft size estimated visually - payers require actual measurement in sq cm. Appeal success rate is approximately 40-60%.
Key documentation requirements for CPT 15730 include: Defect size and location; Flap design and dimensions; Vascular pedicle preservation documented; Donor site closure method. Missing or incomplete documentation is a leading cause of claim denials for this code.
Bundling considerations for CPT 15730: Includes flap design and insetting. Donor site closure included if primary Use an NCCI bundling checker to verify specific code combinations before billing.
Common modifiers for CPT 15730 include: 22 (Increased procedural services), 51 (Multiple procedures if applicable), 62 (Two surgeons if applicable). Modifiers indicate special circumstances and can affect reimbursement or prevent claim denials.
The typical time requirement for CPT 15730 is 3-4 hours typical procedure time. Time-based codes require documentation of the actual time spent providing the service.