CPT 15920Surgery

Exc coccygl pr ulc prim sutr

CPT 15920 covers surgical removal of a pressure ulcer (bedsore) over the tailbone (coccyx) area, including closing the wound with stitches. This is a primary closure procedure performed when the ulcer can be closed directly without requiring skin grafts or flaps.

Showing rates for

National Average

Base Medicare rate

$625.90

This calculator gives a typical-case estimate using standard Medicare modifier rules. Actual payment depends on payer policies, documentation, code-specific CMS status indicators, and locality. Verify before billing.

RVU breakdown

Work RVU

8.29

PE RVU (NF)

8.93

MP RVU

2.13

Total RVU

19.35

Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High

NCCI bundling edits

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Billing tips

Document exact ulcer dimensions (length, width, depth in centimeters) and stage classification in operative report
Impact: Missing measurements account for 35% of denials; proper documentation prevents $625.90 payment loss and supports medical necessity
Verify that closure method is truly primary suture; if any flap or graft is used, different codes (15934-15937) apply and carry higher reimbursement
Impact: Miscoding can result in underpayment of $1,000-$3,000; code 15934 (myocutaneous flap) reimburses significantly higher than 15920
Append modifier 22 with supporting documentation when operative time exceeds typical 90-120 minutes or defect exceeds 10 cm diameter
Impact: Successful modifier 22 claims can increase reimbursement by $125-$315 (20-50% above base rate); include comparison to typical case complexity
Confirm global period is 90 days; all postoperative wound care within this period is bundled and cannot be separately billed
Impact: Attempting to bill wound debridement (11042-11047) or E/M visits during global period will result in denials; plan follow-up billing accordingly
For bilateral or multiple pressure ulcers at different sites, use modifier 59 and bill separately for each distinct anatomical location
Impact: Proper modifier 59 usage can recover full payment for each site; failure to use results in bundling and loss of additional $625.90 per site
Ensure anesthesia code matches surgical complexity; MAC or general anesthesia is typical and supports medical necessity claims
Anesthesia documentation inconsistencies trigger audits; concordant coding supports the 8.29 work RVU intensity assigned to this procedure

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Frequently asked questions

What is the Medicare reimbursement for CPT code 15920 in 2025?

The 2025 Medicare national average reimbursement for CPT 15920 is $625.90 for both facility and non-facility settings. This is based on 19.35 total RVUs (8.29 work RVU + 8.93 PE RVU + 2.13 MP RVU) multiplied by the 2025 conversion factor of 32.3465. Actual payment may vary by geographic locality using the GPCI adjustment factors.

What is the difference between CPT 15920 and 15922?

CPT 15920 is for excision of a coccygeal pressure ulcer with primary suture closure, while 15922 is for excision of a sacral pressure ulcer with primary closure. The key difference is anatomical location: coccygeal refers to the tailbone area, while sacral refers to the larger bone just above. Both codes have similar work values, but precise anatomical documentation is required to select the correct code.

Can I bill CPT 15920 with a skin graft code?

No, CPT 15920 specifically describes primary suture closure. If a skin graft is performed, you should instead report CPT 15931 (excision sacral or coccygeal pressure ulcer with skin flap closure) or the appropriate skin graft code. Using 15920 when a graft was performed constitutes incorrect coding and will result in underpayment or denial upon audit.

What documentation is required to support medical necessity for CPT 15920?

Required documentation includes pressure ulcer stage (typically Stage III or IV), precise measurements, anatomical location, evidence of failed conservative treatment for at least 30 days (wound care, pressure relief, nutritional support), patient's inability to heal without surgical intervention, and detailed operative report describing excision margins and primary closure technique. Photographs are highly recommended to support medical necessity.

What is the global period for CPT 15920?

CPT 15920 has a 90-day global period. This means all routine postoperative care, including wound checks, suture removal, and normal follow-up visits within 90 days after surgery, are included in the $625.90 payment and cannot be billed separately. Only unrelated E/M services (with modifier 24) or complications requiring return to OR (with modifier 78) may be separately reportable.

How many RVUs is CPT code 15920 worth?

CPT 15920 has a total of 19.35 RVUs for 2025, composed of 8.29 work RVUs, 8.93 practice expense RVUs (both facility and non-facility), and 2.13 malpractice RVUs. The work RVU of 8.29 reflects the high complexity and intensity of surgical excision and closure of a coccygeal pressure ulcer.

Can CPT 15920 be performed in an office setting?

While technically possible in very rare circumstances, CPT 15920 is almost always performed in a hospital operating room or ambulatory surgical center due to the complexity of the procedure, need for anesthesia (general or MAC), and potential for significant blood loss. The identical facility and non-facility rates ($625.90) reflect that this procedure requires substantial resources regardless of setting. Office-based performance would be unusual and require exceptional documentation of medical appropriateness.