CPT 15934Surgery

Exc sacral pr ulc skn flap

CPT 15934 covers the surgical removal of a sacral pressure ulcer (bedsore on the tailbone area) along with reconstruction using a skin flap to close the wound. This is a complex procedure typically performed on patients with chronic, deep pressure sores that cannot heal on their own.

Showing rates for

National Average

Base Medicare rate

$965.87

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

13.68

PE RVU (NF)

13.69

MP RVU

2.49

Total RVU

29.86

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

NCCI bundling edits

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Billing tips

Document wound dimensions (length, width, depth in cm), Stage classification (III or IV), and presence of undermining or tunneling in operative note
Impact: Critical for medical necessity determination; undocumented wound characteristics result in 35-40% denial rate
Clearly describe the flap type used (V-Y advancement, gluteal rotation, fasciocutaneous) with detailed dissection and closure technique
Impact: Differentiates 15934 from simple closure codes; prevents downcoding to lower-paying debridement codes (11042-11047) which reimburse $75-250 vs $965.87
Bill separately for bone resection if sacral prominence or coccyx is removed using appropriate add-on codes (15937 for each additional ostectomy)
Impact: 15937 adds approximately $213 per additional osteotomy; frequently overlooked leading to $200+ revenue loss per case
Obtain pre-authorization for Medicare Advantage and commercial payers; many require documentation of failed conservative therapy (minimum 30 days wound care)
Impact: Pre-authorization prevents 60-70% of initial denials; retro-authorization appeals succeed only 40% of the time
Code 15934 applies only to sacral location; use 15936 for ischial ulcers and 15933 for other locations to avoid geographic miscoding denials
Impact: Incorrect anatomic code selection results in automatic denial; proper site coding ensures first-pass payment
When performed in ASC setting, verify facility is approved for complex wound procedures; some payers restrict to hospital inpatient only
Impact: ASC setting uses same rate ($965.87) but facility may face denial if not credentialed; verify before scheduling

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 15934 in 2025?

The 2025 Medicare national average reimbursement for CPT 15934 is $965.87 for both facility and non-facility settings. This is based on 29.86 total RVUs (13.68 work RVU, 13.69 practice expense RVU, 2.49 malpractice RVU) multiplied by the 2025 conversion factor of 32.3465.

What is the difference between CPT 15934 and 15933?

CPT 15934 is specific to sacral pressure ulcer excision with skin flap closure, while CPT 15933 covers pressure ulcer excision with flap closure at other locations (such as trochanteric areas). The anatomical location determines which code to use; incorrect site coding will result in claim denial.

Can CPT 15934 be billed with debridement codes on the same date?

No, CPT 15934 is a comprehensive code that includes all debridement performed as part of the ulcer excision. Billing separate debridement codes (11042-11047) on the same date will typically result in bundling denials. The extensive debridement should be described in the operative note to justify the 15934 code selection.

What documentation is required to support medical necessity for CPT 15934?

Required documentation includes pressure ulcer Stage classification (III or IV), wound measurements in three dimensions, evidence of failed conservative treatment for at least 30 days, description of tissue layers involved (must involve deeper structures beyond skin), operative note detailing flap type and technique, and postoperative wound care plan.

How many RVUs is CPT code 15934 worth in 2025?

CPT 15934 has a total of 29.86 RVUs in 2025, consisting of 13.68 work RVUs, 13.69 practice expense RVUs (both facility and non-facility), and 2.49 malpractice RVUs according to the CMS Medicare Physician Fee Schedule.

Can CPT 15934 be performed in an ASC or only in hospital inpatient setting?

CPT 15934 can be performed in hospital inpatient, hospital outpatient, or ASC settings. The Medicare reimbursement rate is $965.87 regardless of setting. However, individual commercial payers may restrict the procedure to inpatient settings for complex cases, so verify payer policy before scheduling.

What modifier should be used if the sacral pressure ulcer repair was more complex than usual?

Use modifier 22 (Increased Procedural Services) when the sacral ulcer excision requires significantly greater complexity, such as wounds exceeding 10cm, multiple bony prominences requiring resection, or extensive scarring. This requires detailed documentation of additional time and work, and can increase reimbursement by 20-50% with proper justification.