$426.22
15630 identifies work at the eyelid, nose, ear, or lip. Select 15620 for the other regions named in that code’s descriptor.
On this page
CMS RVU26D · Effective 2026-10-01
15630 Flap staging Medicare reimbursement rates in Kentucky
Reports a staged flap delay or pedicle sectioning involving the eyelid, nose, ear, or lip during reconstructive surgery. Compare 15630 office and facility rates across CMS payment localities in Kentucky.
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 15630 in Kentucky?
Kentucky 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
$433.01
1 of 1 localities have a supported rate.
Payment area: Kentucky
One mapped payment locality.
Facility setting
$291.97
1 of 1 localities have a supported rate.
Payment area: Kentucky
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 15630: Facial flap delay or sectioning
Reports a staged flap delay or pedicle sectioning involving the eyelid, nose, ear, or lip during reconstructive surgery.
Code 15630 covers a surgical stage that delays a flap or divides or sections its pedicle at the eyelid, nose, ear, or lip. In staged reconstruction, a surgeon may return to divide a previously transferred flap after it has developed blood supply from recipient tissues; nasal reconstruction with a staged forehead flap is a common example. Plastic and reconstructive surgeons, facial plastic surgeons, and oculoplastic surgeons may perform this work in an operating room or other surgical setting.
Report the code for the delay or sectioning stage, not for the original flap creation or transfer. The operative report should identify the flap, site, and work performed. The code has a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur in the same session, Medicare pays the highest-valued procedure in full and other procedures at 50%. Modifier 50 is inappropriate. Medicare does not pay an assistant at surgery for this code; co-surgeons and team surgery are not permitted.
CMS billing rules for 15630
- 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 RVU3.98 · 28%
- Practice expense (office) RVU9.55 · 68%
- Malpractice RVU0.54 · 4%
5.2K
Medicare services in 2024 · #1844 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.
15630 compared with similar codes
Office rates for Kentucky, from the same CMS release.
$357.49
15610 identifies flap delay or sectioning on the arms or legs; 15630 is for the specified eyelid, nose, ear, and lip sites.
$542.08
15650 describes transfer of a skin pedicle flap. Use 15630 for flap delay or pedicle sectioning rather than the transfer itself.
Compare 15630 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
Kentucky →
Office / nonfacility
$433.01
Facility
$291.97
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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 15630 in Kentucky.
PPRRVU2026_Oct_nonQPP.csv
1,527
- Code
- 15630
- Physician work
- 3.98
- Practice expense
- 9.55
- Malpractice
- 0.54
GPCI2026.csv
55
- Locality
- Kentucky
- Physician work
- 1.000
- Practice expense
- 0.889
- Malpractice
- 0.915
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 3.98 | × 1.000 | 3.9800 |
| Practice expense | 9.55 | × 0.889 | 8.4900 |
| Malpractice | 0.54 | × 0.915 | 0.4941 |
| Total RVUs | 12.9641 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Kentucky$433.01
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 3.98 | 1 |
| Practice expense | 9.55 | 0.889 |
| Malpractice | 0.54 | 0.915 |
(3.98 × 1 + 9.55 × 0.889 + 0.54 × 0.915) × $33.4009 = $433.01
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 3.98 | 1 |
| Practice expense | 4.8 | 0.889 |
| Malpractice | 0.54 | 0.915 |
(3.98 × 1 + 4.8 × 0.889 + 0.54 × 0.915) × $33.4009 = $291.97
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.
15630 billing questions
How does 15630 differ from other flap-delay codes?
Use 15630 for delay or sectioning at the eyelid, nose, ear, or lip. Codes 15600, 15610, and 15620 identify other anatomic regions.
Does 15630 describe the original flap transfer?
No. It describes a flap-delay or sectioning stage. The operative report should distinguish that work from the earlier creation or transfer of the flap.
Are routine postoperative visits separately included?
Related postoperative care during the 90-day global period is included, along with the day-before preoperative visit.
Should modifier 50 be appended for work on both sides?
No. CMS identifies bilateral adjustment as inappropriate for this code.
Can an assistant or co-surgeon be reported?
Medicare does not pay an assistant at surgery for 15630. 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.
1,52415600,,Delay flap trunk,A,,1.96,8.85,,4.04,,0.37,11.18,6.37,0,090,0.10,0.71,0.19,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,52515610,,Delay flap arms/legs,A,,2.46,8.84,,4.17,,0.42,11.72,7.05,0,090,0.10,0.71,0.19,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,52615620,,Delay flap f/c/c/n/ax/g/h/f,A,,3.66,9.64,,4.88,,0.58,13.88,9.12,0,090,0.10,0.71,0.19,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,52715630,,Delay flap eye/nos/ear/lip,A,,3.98,9.55,,4.80,,0.54,14.07,9.32,0,090,0.10,0.71,0.19,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,52815650,,Transfer skin pedicle flap,A,,4.65,12.13,,5.94,,0.87,17.65,11.46,0,090,0.10,0.71,0.19,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,52915730,,Mdfc flap w/prsrv vasc pedcl,A,,13.16,28.48,,8.77,,1.49,43.13,23.42,0,090,0.10,0.71,0.19,2,0,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,53015731,,Forehead flap w/vasc pedicle,A,,14.02,18.22,,10.11,,2.14,34.38,26.27,0,090,0.10,0.71,0.19,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5208102,IN,00,INDIANA,1.000,0.927,0.486
5305102,IA,00,IOWA,1.000,0.915,0.397
5405202,KS,00,KANSAS,1.000,0.904,0.504
5515102,KY,00,KENTUCKY,1.000,0.889,0.915
5607202,LA,01,NEW ORLEANS,1.000,0.941,1.136
5707202,LA,99,REST OF LOUISIANA,1.000,0.885,0.958
5814112,ME,03,SOUTHERN MAINE,1.000,0.991,0.631