| Code | Description | States | Median rate |
|---|---|---|---|
| 15002 | Wound bed prep for a graft, body or limb, first 100 sq cm | 48 | $270.61 |
| 15004 | Wound bed prep for a graft, face/hand/foot, first 100 sq cm | 48 | $312.50 |
| 15100 | Split-thickness skin graft, body or limb, first 100 sq cm | 48 | $688.02 |
| 15101 | Split-thickness skin graft, body or limb, added 100 sq cm | 47 | $156.39 |
| 15120 | Split-thickness skin graft, face/hand/foot, first 100 sq cm | 48 | $696.63 |
| 15121 | Split-thickness skin graft, face/hand/foot, added 100 sq cm | 47 | $176.37 |
| 15200 | Full-thickness skin graft, trunk, up to 20 sq cm | 48 | $632.02 |
| 15201 | Full-thickness skin graft, trunk, each added 20 sq cm | 47 | $114.48 |
| 15220 | Full-thickness skin graft, scalp, arm or leg, up to 20 sq cm | 48 | $585.78 |
| 15221 | Full-thickness skin graft, scalp/arm/leg, added 20 sq cm | 47 | $107.74 |
| 15240 | Full-thickness skin graft, face or hand, up to 20 sq cm | 48 | $710.75 |
| 15241 | Full-thickness skin graft, face or hand, added 20 sq cm | 47 | $141.52 |
| 15260 | Full-thickness skin graft, nose, ear or lip, up to 20 sq cm | 48 | $763.37 |
| 15261 | Full-thickness skin graft, nose/ear/lip, added 20 sq cm | 47 | $167.61 |
| 15271 | Skin substitute graft, body or limb, first 25 sq cm | 48 | $120.62 |
| 15272 | Skin substitute graft, body or limb, each added 25 sq cm | 47 | $20.67 |
| 15275 | Skin substitute graft, face, hand or foot, first 25 sq cm | 48 | $123.33 |
| 15276 | Skin substitute graft, face or hand, each added 25 sq cm | 47 | $26.91 |
| 15771 | Fat grafting by liposuction, body or limbs, up to 50 cc | 44 | $519.90 |
| 15772 | Fat grafting by liposuction, body or limbs, each added 50 cc | 42 | $159.72 |
| 15773 | Fat grafting by liposuction, face or hands, up to 25 cc | 43 | $509.48 |
| 15774 | Fat grafting by liposuction, face or hands, each added 25 cc | 41 | $154.82 |
| 15776 | Hair transplant punch grafts, more than 15 | 10 | $369.88 |
| 15777 | Biologic mesh for soft tissue reinforcement (add-on) | 46 | $179.12 |
| 15780 | Dermabrasion, whole face | 34 | $634.51 |
| 15781 | Dermabrasion, part of the face | 35 | $397.98 |
| 15782 | Dermabrasion, area other than face | 33 | $389.64 |
| 15783 | Dermabrasion, superficial | 27 | $299.34 |
| 15786 | Abrasion of a single skin lesion | 34 | $162.37 |
| 15787 | Abrasion of skin lesions, each added 4 or fewer | 34 | $25.03 |
| 15788 | Chemical peel, face, surface layer | 25 | $253.74 |
| 15789 | Chemical peel, face, deep layer | 26 | $376.99 |
| 15792 | Chemical peel, body, surface layer | 27 | $265.05 |
| 15793 | Chemical peel, body, deep layer | 27 | $334.27 |
| 15820 | Lower eyelid lift (blepharoplasty) | 42 | $475.54 |
| 15821 | Lower eyelid lift with fat pad removal | 41 | $518.74 |
| 15822 | Upper eyelid lift (blepharoplasty) | 45 | $374.03 |
| 15823 | Upper eyelid lift for skin that blocks vision | 48 | $511.20 |
| 15824 | Facelift, forehead | 16 | $510.00 |
| 15825 | Facelift, neck with muscle tightening | 16 | $637.50 |
| 15826 | Facelift, frown lines between the brows | 16 | $448.87 |
| 15828 | Facelift, cheek, chin and neck | 15 | $1,241.20 |
| 15829 | Facelift with deep layer (SMAS) flap | 16 | $1,504.22 |
| 15830 | Removal of excess belly skin and fat (panniculectomy) | 44 | $889.69 |
| 15832 | Excess skin removal, thigh | 32 | $685.07 |
| 15833 | Excess skin removal, lower leg | 30 | $632.91 |
| 15834 | Excess skin removal, hip | 30 | $650.18 |
| 15835 | Excess skin removal, buttock | 29 | $690.84 |
| 15836 | Excess skin removal, arm | 29 | $578.42 |
| 15837 | Excess skin removal, forearm or hand | 28 | $688.75 |
| 15838 | Excess skin and fat removal under the chin | 29 | $471.62 |
| 15839 | Excess skin removal, other area | 35 | $679.82 |
| 15847 | Tummy tuck (abdominoplasty) with belly button move (add-on) | 29 | $349.14 |
| 15852 | Dressing change under anesthesia | 47 | $37.51 |
| 15853 | Suture or staple removal, no anesthesia (add-on) | 44 | $10.26 |
| 15854 | Suture and staple removal, no anesthesia (add-on) | 44 | $13.63 |
| 15860 | IV dye injection to check blood flow in a flap | 42 | $83.81 |
| 15876 | Liposuction, head and neck | 16 | $482.18 |
| 15877 | Liposuction, trunk | 17 | $1,035.19 |
| 15878 | Liposuction, arm | 14 | $510.00 |
| 15879 | Liposuction, leg | 14 | $652.08 |
| 15999 | Unlisted skin procedure | 11 | $537.76 |
Published Medicaid fee-for-service schedule amounts, not a coverage or eligibility guarantee. Managed-care plan rates can differ. Where no prior-authorization flag is shown, the state does not publish one. Descriptions are ProviderSignal's own plain-language labels or public-domain CMS text.