$764.89
Both codes cover adjacent tissue transfer on the scalp, arms, or legs. Choose 14020 for defects of 10 square centimeters or less; 14021 is for 10.1 through 30 square centimeters.
On this page
CMS RVU26D · Effective 2026-10-01
14021 Tissue transfer Medicare reimbursement rates in Guam
Reports local tissue rearrangement to repair a scalp, arm, or leg defect when the combined defect area measures 10.1 through 30 square centimeters. Compare 14021 office and facility rates across CMS payment localities in Guam.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 14021 in Guam?
Guam has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
$935.93
1 of 1 localities have a supported rate.
Payment area: Hawaii, Guam
One mapped payment locality.
Facility setting
$637.43
1 of 1 localities have a supported rate.
Payment area: Hawaii, Guam
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Reconstructive surgery
About 14021: Adjacent tissue transfer, scalp or extremity
Reports local tissue rearrangement to repair a scalp, arm, or leg defect when the combined defect area measures 10.1 through 30 square centimeters.
A surgeon mobilizes nearby skin and tissue to close a defect on the scalp, arm, or leg, using techniques such as a rotation, advancement, or transposition flap. This reconstruction is common after removal of a skin cancer or another lesion leaves a defect that cannot be closed directly. Plastic surgeons, dermatologic surgeons, and other surgeons may perform it in an office procedure room or operating room. The procedure includes the work of transferring and rearranging the adjacent tissue.
Select this code when the total defect area is 10.1 through 30 square centimeters. Measure the primary defect and any secondary defect created by the tissue movement; document the dimensions and flap technique in the operative note. The lesion excision and closure of the secondary defect are included, so do not separately report lesion removal or a simple repair for that work. Medicare assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur in one session, the highest-valued is paid in full and others at 50%. Medicare does not pay an assistant at surgery for this code; co-surgeons and team surgery are not permitted.
CMS billing rules for 14021
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- Assistant at surgery
- Statutory restriction: assistant at surgery is not paid.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU9.48 · 36%
- Practice expense (office) RVU15.64 · 59%
- Malpractice RVU1.31 · 5%
21.8K
Medicare services in 2024 · #1115 by national volume
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
14021 compared with similar codes
Office rates for Guam, from the same CMS release.
$905.70
The area range is the same, but 14001 is for trunk defects. Use 14021 for defects on the scalp, arms, or legs.
$980.92
The area range is the same, but 14041 covers specified face, ear, eyelid, nose, lip, or mucous membrane sites rather than the scalp, arms, or legs.
$1,179.30
Use 14301 for an adjacent tissue transfer defect measuring 30.1 through 60 square centimeters. Code 14021 is limited to 10.1 through 30 square centimeters at its specified sites.
Compare 14021 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Hawaii, Guam →
Office / nonfacility
$935.93
Facility
$637.43
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 14021 in Hawaii, Guam.
PPRRVU2026_Oct_nonQPP.csv
1,450
- Code
- 14021
- Physician work
- 9.48
- Practice expense
- 15.64
- Malpractice
- 1.31
GPCI2026.csv
46
- Locality
- Hawaii, Guam
- Physician work
- 1.000
- Practice expense
- 1.137
- Malpractice
- 0.579
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 9.48 | × 1.000 | 9.4800 |
| Practice expense | 15.64 | × 1.137 | 17.7827 |
| Malpractice | 1.31 | × 0.579 | 0.7585 |
| Total RVUs | 28.0212 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Hawaii, Guam$935.93
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 9.48 | 1 |
| Practice expense | 15.64 | 1.137 |
| Malpractice | 1.31 | 0.579 |
(9.48 × 1 + 15.64 × 1.137 + 1.31 × 0.579) × $33.4009 = $935.93
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 9.48 | 1 |
| Practice expense | 7.78 | 1.137 |
| Malpractice | 1.31 | 0.579 |
(9.48 × 1 + 7.78 × 1.137 + 1.31 × 0.579) × $33.4009 = $637.43
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
14021 billing questions
How is 14021 distinguished from 14020?
Use 14020 for a defect of 10 square centimeters or less. Use 14021 when the measured defect area is 10.1 through 30 square centimeters.
What area should the operative note document?
Document the dimensions of the primary defect and any secondary defect created by moving the tissue. The combined defect area determines the code, not the size of the flap alone.
Can the lesion excision be billed separately?
The excision that creates the defect is included in the adjacent tissue transfer. Do not separately report lesion removal for the same work.
Is closure of the donor or secondary defect separately reportable?
The closure associated with transferring the adjacent tissue is part of the procedure. Do not separately report a simple repair for that closure.
What postoperative care is included?
Medicare assigns a 90-day global period. It includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant or co-surgeon be reported?
Medicare does not pay an assistant at surgery for 14021. Co-surgeons and team surgery are not permitted.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
1,44714001,,Tis trnfr trunk 10.1-30sqcm,A,,8.56,15.49,,7.83,,1.63,25.68,18.02,0,090,0.10,0.71,0.19,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,4481400F,,Prkns diag rviewed,I,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
1,44914020,,Tis trnfr s/a/l 10 sq cm/<,A,,7.04,13.44,,7.07,,1.00,21.48,15.11,0,090,0.10,0.71,0.19,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,45014021,,Tis trnfr s/a/l 10.1-30 sqcm,A,,9.48,15.64,,7.78,,1.31,26.43,18.57,0,090,0.10,0.71,0.19,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,45114040,,Tis trnfr f/c/c/m/n/a/g/h/f,A,,8.39,13.51,,6.89,,1.07,22.97,16.35,0,090,0.10,0.71,0.19,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,45214041,,Tis trnfr f/c/c/m/n/a/g/h/f,A,,10.56,15.89,,7.70,,1.28,27.73,19.54,0,090,0.10,0.71,0.19,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,45314060,,Tis trnfr e/n/e/l 10 sq cm/<,A,,9.00,13.04,,7.10,,1.07,23.11,17.17,0,090,0.10,0.71,0.19,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4309102,FL,99,REST OF FLORIDA,1.000,0.956,1.503
4410212,GA,01,ATLANTA,1.003,1.016,1.201
4510212,GA,99,REST OF GEORGIA,1.000,0.892,1.192
4601212,HI,01,"HAWAII, GUAM",1.000,1.137,0.579
4702202,ID,00,IDAHO,1.000,0.920,0.473
4806102,IL,16,CHICAGO,1.007,1.005,2.295
4906102,IL,12,EAST ST. LOUIS,1.000,0.920,2.014