No office rate
Use 15734 when the flap reconstruction is on the trunk; use 15738 for a lower-extremity flap.
On this page
CMS RVU26D · Effective 2026-10-01
15738 Lower-extremity flap Medicare reimbursement rates in Idaho
Reports reconstruction of a lower-extremity defect with a transferred flap containing muscle, skin, or fascia that retains its blood supply. Compare 15738 office and facility rates across CMS payment localities in Idaho.
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 15738 in Idaho?
Idaho 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
No supported rate
Facility setting
$1052.00
1 of 1 localities have a supported rate.
Payment area: Idaho
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 15738: Pedicled flap reconstruction of lower extremity
Reports reconstruction of a lower-extremity defect with a transferred flap containing muscle, skin, or fascia that retains its blood supply.
This code covers reconstruction of a lower-extremity defect using a flap that includes muscle, skin, or fascia and remains connected to its blood supply during transfer. Plastic surgeons and other surgeons performing reconstructive procedures may use this approach to provide durable tissue coverage when a defect cannot be adequately managed with a simpler closure. The operative report should identify the flap tissue, its lower-extremity donor and recipient sites, and how the tissue was mobilized and positioned.
Select this code for a pedicled flap reconstruction of the leg, not a free flap moved with microvascular vessel connections. The 90-day global period includes 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. An assistant at surgery may be paid; co-surgeons require supporting documentation, and team surgery is not permitted.
CMS billing rules for 15738
- 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
- Assistant at surgery may be paid.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU18.56 · 54%
- Practice expense (office) RVU12.20 · 35%
- Malpractice RVU3.62 · 11%
6.1K
Medicare services in 2024 · #1743 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.
15738 compared with similar codes
Office rates for Idaho, from the same CMS release.
No office rate
Use 15736 for an arm flap reconstruction. The site for 15738 is the lower extremity.
No office rate
15756 describes free muscle or myocutaneous tissue transfer with microvascular anastomosis; 15738 is for a flap that retains its blood supply during transfer.
Compare 15738 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
Idaho →
Office / nonfacility
Unavailable
Facility
$1052.00
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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 15738 in Idaho.
PPRRVU2026_Oct_nonQPP.csv
1,534
- Code
- 15738
- Physician work
- 18.56
- Practice expense
- 12.20
- Malpractice
- 3.62
GPCI2026.csv
47
- Locality
- Idaho
- Physician work
- 1.000
- Practice expense
- 0.920
- Malpractice
- 0.473
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 18.56 | × 1.000 | 18.5600 |
| Practice expense | 12.20 | × 0.920 | 11.2240 |
| Malpractice | 3.62 | × 0.473 | 1.7123 |
| Total RVUs | 31.4963 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Idaho$1052.00
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 18.56 | 1 |
| Practice expense | 12.2 | 0.92 |
| Malpractice | 3.62 | 0.473 |
(18.56 × 1 + 12.2 × 0.92 + 3.62 × 0.473) × $33.4009 = $1052.00
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.
15738 billing questions
How does this differ from a free muscle flap?
This code describes a lower-extremity flap that remains connected to its blood supply during transfer. A free flap, such as the service represented by 15756, is detached and reconnected using microvascular techniques.
Is modifier 50 appropriate when both legs are treated?
No. CMS identifies bilateral adjustment as inapplicable to this code, so modifier 50 is inappropriate.
What documentation supports reporting this flap?
Document the defect and recipient site, the lower-extremity donor site, the tissue included in the flap, and the method of mobilization and transfer.
Can an assistant surgeon be reported?
CMS permits payment for an assistant at surgery. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
How is this code affected when other 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.
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.
1,53115733,,Musc myoq/fscq flp h&n pedcl,A,,15.29,9.32,NA,9.32,,2.58,27.19,27.19,0,090,0.10,0.71,0.19,2,0,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,53215734,,Muscle-skin graft trunk,A,,22.43,14.11,NA,14.11,,4.98,41.52,41.52,0,090,0.10,0.71,0.19,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,53315736,,Muscle-skin graft arm,A,,16.61,13.35,NA,13.35,,3.31,33.27,33.27,0,090,0.10,0.71,0.19,2,0,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,53415738,,Muscle-skin graft leg,A,,18.56,12.20,NA,12.20,,3.62,34.38,34.38,0,090,0.10,0.71,0.19,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,53515740,,Island pedicle flap graft,A,,11.51,18.07,,9.14,,1.84,31.42,22.49,0,090,0.10,0.71,0.19,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,53615750,,Neurovascular pedicle flap,A,,12.64,10.10,NA,10.10,,2.40,25.14,25.14,0,090,0.10,0.71,0.19,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,53715756,,Free myo/skin flap microvasc,A,,36.02,16.83,NA,16.83,,5.89,58.74,58.74,0,090,0.10,0.71,0.19,2,0,2,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
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
5006102,IL,15,SUBURBAN CHICAGO,1.007,1.027,1.772