CPT 15931Surgery

Exc sacral pr ulc prim sutr

CPT 15931 covers surgical removal of a pressure ulcer (bedsore) over the tailbone area, where the surgeon cuts out the damaged tissue and stitches the wound closed directly without using skin grafts or flaps.

Showing rates for

National Average

Base Medicare rate

$692.86

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

10.07

PE RVU (NF)

8.97

MP RVU

2.38

Total RVU

21.42

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

NCCI bundling edits

Loading bundling edits…

Billing tips

Document exact ulcer dimensions (length, width, depth in cm) and stage (III or IV) in operative report to justify 15931 rather than simpler debridement codes
Impact: Prevents downcoding to 11042-11047 debridement codes worth $72-$340, protecting the full $692.86 reimbursement
Clearly document that closure was PRIMARY (direct suturing) rather than requiring skin grafts, muscle flaps, or secondary healing to differentiate from 15933-15937
Impact: Prevents confusion with higher-complexity codes (15933: $1,100+) or incorrect bundling denials
Bill facility vs non-facility based on site of service; both rates are identical at $692.86 for 15931, but verify place of service code matches claim form
Impact: Ensures clean claims processing; incorrect POS codes trigger automatic denials requiring resubmission
Append modifier 22 with detailed operative note and cover letter when ulcer exceeds 10cm in any dimension or requires extensive undermining closure
Impact: Can increase reimbursement by $138-$208 (20-30%) with proper documentation of significantly increased complexity
Verify pressure ulcer ICD-10 code specifies sacral location (L89.15x series) and stage; non-specific codes trigger medical review
Impact: Prevents payment delays from ADR (Additional Documentation Requests) that average 30-45 day hold on payment
Do not bundle with same-day ostomy care, wound VAC placement, or separately identifiable E/M unless modifier 25 clearly documents distinct service
Impact: Prevents $100-$250 in bundled denials for separately billable services performed same day

Live Field Datano reports yet

Real billers contribute denial patterns and appeal strategies for this code. Once 5+ reports come in, you’ll see live aggregated data here — the only place this exists, free.

Working with CPT 15931?

Get the free Revenue Protection Toolkit — the denial triggers, modifier pitfalls, and bundling conflicts that quietly cost you reimbursement. Instant download.

Help build the field knowledge

MedPayIQ gets smarter as billers contribute. If you've had this code denied, share what happened so others learn from it. Anonymous, no patient info.

Related actions

Frequently asked questions

What is the Medicare reimbursement rate for CPT 15931 in 2025?

The 2025 Medicare national average reimbursement for CPT 15931 is $692.86 for both facility and non-facility settings. This is based on 21.42 total RVUs (10.07 work RVU, 8.97 PE RVU, 2.38 MP RVU) multiplied by the 2025 conversion factor of 32.3465.

What is the difference between CPT 15931 and debridement codes 11042-11047?

CPT 15931 involves surgical excision of the entire pressure ulcer with removal of all necrotic and damaged tissue followed by primary closure with sutures. Debridement codes 11042-11047 cover removal of devitalized tissue only without formal excision or primary closure, typically leaving wounds to heal by secondary intention or requiring grafts/flaps later.

Can CPT 15931 be billed with skin graft codes?

No, CPT 15931 specifically describes primary suture closure. If a skin graft is required, you should instead use CPT 15933 (excision sacral pressure ulcer with primary suture over muscle flap) or 15934-15937 depending on the reconstruction technique. Billing 15931 with graft codes will result in bundling denials.

What ulcer stage qualifies for CPT 15931?

CPT 15931 is typically appropriate for Stage III or Stage IV sacral pressure ulcers that require surgical excision. Stage I and II ulcers usually respond to conservative management and would not meet medical necessity criteria for surgical excision with primary closure.

How do I bill for bilateral sacral pressure ulcer excision?

The sacral region is anatomically midline, so truly bilateral sacral ulcers are uncommon. If you have two distinct sacral ulcers requiring separate excisions, append modifier 59 or XS to the second 15931 code with clear documentation of separate anatomic sites. Each excision must be independently documented with separate measurements and closure descriptions.

What is the global period for CPT 15931?

CPT 15931 has a 90-day global surgical period. All routine post-operative care related to the pressure ulcer excision is included in the $692.86 reimbursement. Unrelated E/M services require modifier 24, complications requiring return to OR need modifier 78, and planned staged procedures need modifier 58.

What ICD-10 codes should be used with CPT 15931?

Use ICD-10 codes from the L89.15x series for sacral pressure ulcers, with the sixth character specifying stage: L89.153 (stage 3), L89.154 (stage 4), L89.156 (pressure-induced deep tissue damage). Unstageable ulcers use L89.150. The specific stage code must match the operative documentation to support medical necessity for surgical excision.