Billing code 15740: Island flapMedicare rate & RVUs in Guam
Reports reconstruction of a tissue defect with an island of skin and underlying tissue moved on its attached vascular pedicle.
Medicare pays $1,106.27 for 15740 in the office in Guam (Hawaii, Guam). Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 9 sections
What 15740 covers
The surgeon raises an island of skin with underlying tissue while preserving its vascular attachment, then moves it into a nearby defect. The flap provides tissue for coverage after excision, trauma, or another operation when a graft or simple closure would not adequately reconstruct the site. Plastic, facial plastic, otolaryngology, and hand surgeons may perform this procedure in an operating room or, for selected cases, an office procedure setting.
Report the code when the operative note supports transfer of an island flap on a subcutaneous vascular pedicle, rather than a free flap or a different named pedicle flap. Documentation should identify the defect, flap design and tissue transferred, preserved pedicle, and how the flap was inset. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple-procedure reduction. Modifier 50 is inappropriate. CMS restricts assistant-at-surgery payment and does not permit co-surgeons or team surgery for this code.
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.
15740 in Hawaii, Guam
| Payment locality | Office | Facility |
|---|---|---|
| Hawaii, Guam | $1,106.27 | $767.14 |
How the 15740 rate is calculated
Each of 15740’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 15740
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 11.51Practice expense 18.07Malpractice 1.84
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 15740
15740 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 15740
Island flap
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.10/0.71/0.19 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 15740
Island flap
90-day global period ends
Dec 30, 2026
Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).
Visit on Oct 31, 2026
Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
15740 without 51 · national office
$1,049.46
Island flap
15740-51 · Second procedure: 50%
$524.73
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
15740 compared with similar codes
Compare codes
15740 vs 15750 vs 15731 vs 14040: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 15750Pedicle flap
- Choose 15740 for an island flap based on its vascular attachment; 15750 describes a neurovascular pedicle flap.
- 15731Forehead flap
- 15731 identifies a forehead flap, a site-specific option for facial reconstruction. Use 15740 when the documented procedure is an island flap rather than that forehead-flap technique.
- 14040Tissue rearrangement
- 14040 describes local tissue rearrangement. Choose 15740 when the surgeon transfers an island of tissue while maintaining its vascular pedicle.
15740 billing questions
How is an island pedicle flap different from local tissue rearrangement?
Use 15740 when the operative technique transfers an island of tissue on an attached vascular pedicle. Local tissue rearrangement codes describe a different advancement, rotation, or transposition approach.
When would 15750 be a better choice?
Compare the operative technique and the type of pedicle documented. 15750 describes a neurovascular pedicle flap; 15740 describes an island flap carried on its vascular pedicle.
Can modifier 50 be appended for flaps on both sides?
No. CMS identifies bilateral adjustment as inappropriate for this code’s descriptor or anatomy.
Does the code include related postoperative visits?
Yes. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant or co-surgeon be reported?
CMS applies a statutory restriction on assistant-at-surgery payment for 15740 and does not permit co-surgeons or team surgery.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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