2025 CPT code 15278
(Active) Effective Date: N/A Revision Date: N/A Surgery - Surgical Procedures on the Integumentary System Surgery Feed
Application of additional skin substitute graft to various body areas; each additional 100 sq cm or 1% body surface area (infants/children).
Modifiers may be applicable depending on the circumstances of the service. For instance, modifier 59 may be necessary if this service is performed as a distinct procedural service or if additional services are performed in the same session. Always consult the relevant coding guidelines.
Medical necessity is established by the presence of a wound that requires skin substitute grafting for appropriate healing and restoration of skin integrity. The size of the wound and the type of injury should be clearly documented, along with the rationale for using a skin substitute graft.
The clinical responsibility includes wound assessment, preparation of the wound bed, selection and preparation of the appropriate skin substitute graft, meticulous application of the graft to ensure proper adherence and coverage, and post-operative wound care instructions.
In simple words: This code covers the cost of extra skin grafts needed when a large wound needs more than one skin graft.It's only used if a first graft (covered by a different code) has already been applied. The doctor will add this code if the wound is very large.
This CPT code, 15278, reports the application of each additional 100 square centimeters (sq cm) of skin substitute graft to wounds on the face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits.For infants and children under 10 years old, the unit of measure is each additional 1% of the total body surface area. This code is an add-on code and must be used in conjunction with CPT code 15277. It is used when the total wound surface area exceeds 100 sq cm (or 1% of body surface area for infants/children) requiring additional grafting beyond the initial 100 sq cm (or 1%) covered by 15277.
Example 1: A 12-year-old patient sustains a severe burn injury to his face, resulting in a 150 sq cm wound. CPT code 15277 is used for the first 100 sq cm, and 15278 is added for the additional 50 sq cm., A 60-year-old patient undergoes a complex surgical procedure resulting in a large wound requiring skin substitute grafting. 15277 is used for the initial 100 sq cm, and additional 15278 codes are added for each subsequent 100 sq cm until the entire wound is covered., An infant with a large congenital skin defect undergoes skin substitute grafting.Given that the wound size exceeds 1% of the total body surface area, CPT code 15277 is used for the initial 1% of body surface area, and additional 15278 codes are added for each subsequent 1% until full coverage is achieved.
Thorough documentation is crucial, including detailed wound assessment (size, location, depth, presence of infection, etc.), type and quantity of skin substitute used, images of the wound before and after the procedure, and post-operative care instructions.Surgical notes must clearly indicate the total wound size and the area covered by each application of skin substitute.
** Accurate measurement of the wound surface area is critical for proper coding.Always confirm payer-specific guidelines and local coverage determinations (LCDs) before submitting claims.This is an add-on code requiring a primary procedure code.
- Revenue Code: P5A (Ambulatory Procedures - Skin)
- RVU: The RVUs for this code vary depending on geographic location, facility type, and other payer-specific factors. Consult your local Medicare fee schedule or payer-specific reimbursement guidelines for the most accurate RVU values.
- Global Days: This add-on code does not have a defined global period. The global period is associated with the primary procedure code (15277) used in conjunction with 15278.
- Payment Status: Active
- Modifier TC rule: A technical component (TC) modifier is not directly applicable to this add-on code (15278). The TC modifier usually applies to the professional component of the primary procedure (15277).
- Fee Schedule: Historical fee schedule data is unavailable without access to specific payer data from previous years. This data varies by payer and geographic location.
- Specialties:Plastic Surgery, Burn Surgery, General Surgery
- Place of Service:Inpatient Hospital, Outpatient Hospital, Ambulatory Surgical Center