CPT 15935Surgery

Exc sac pr ulc skn flp ostc

CPT code 15935 covers the surgical removal of a pressure ulcer (bedsore) in the sacral area (lower back/tailbone region) with closure using a skin flap to cover the wound. This is a complex procedure requiring movement of healthy tissue to repair the damaged area.

Showing rates for

National Average

Base Medicare rate

$1,133.42

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

15.78

PE RVU (NF)

16.37

MP RVU

2.89

Total RVU

35.04

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

NCCI bundling edits

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Billing tips

Document complete ulcer staging using NPUAP/EPUAP classification system and precise anatomic location (sacral vs. ischial) with measurements in operative report
Impact: Prevents downcoding to debridement codes (11042-11047) which reimburse 80-90% less; ensures medical necessity justification
Separately document and code ostectomy component with detailed description of bone involvement and amount of bone removed
Impact: Differentiates 15935 from 15933 (without ostectomy, pays $200-300 less depending on payer); ostectomy must be clearly documented to support code selection
Capture and bill for preoperative medical optimization services separately using appropriate E/M codes with modifier 25 prior to global period start
Impact: Additional $100-300 reimbursement for complex medical management, wound assessment, and surgical planning visits
Use modifier 22 with detailed operative report when flap dimensions exceed 10x15 cm or procedure time exceeds 3 hours due to complexity
Impact: Potential 20-50% increase ($226-$567 additional) with proper documentation of increased physician work and time
Ensure separate billing for intraoperative cultures and pathology specimens with appropriate 88305 codes for tissue examination
Impact: Additional $40-60 per specimen; critical for osteomyelitis diagnosis and antibiotic management
Document failed conservative treatment duration (minimum 30 days) including specific modalities attempted (pressure relief surfaces, wound care protocols, nutritional support)
Strengthens medical necessity defense against denials; prevents $1133.42 claim rejection for lack of conservative care trial

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 15935 in 2025?

The 2025 Medicare national average reimbursement for CPT 15935 is $1133.42 for both facility and non-facility settings. This rate is based on 35.04 total RVUs (15.78 work RVU + 16.37 practice expense RVU + 2.89 malpractice RVU) multiplied by the 2025 conversion factor of 32.3465.

What is the difference between CPT 15933 and 15935?

CPT 15935 includes ostectomy (bone removal) as part of the pressure ulcer excision and closure, while 15933 is excision with skin flap closure but without bone removal. The presence and documentation of ostectomy is the key differentiator, with 15935 reimbursing significantly higher due to the additional surgical complexity of bone debridement.

Can CPT 15935 be billed bilaterally for ischial ulcers?

Yes, 15935 can be billed for bilateral ischial pressure ulcers using modifier 50 (bilateral procedure) or by billing each side separately with LT/RT modifiers and modifier 59 to indicate distinct anatomic sites. Documentation must clearly show two separate ulcers requiring independent excision and closure procedures.

What documentation is required to justify medical necessity for CPT 15935?

Required documentation includes: Stage III or IV pressure ulcer classification, precise measurements and location, minimum 30 days of failed conservative treatment (pressure relief, wound care, nutritional support), pre-operative assessment showing functional impact, evidence of underlying bone involvement or osteomyelitis risk, and patient optimization attempts. Photographic documentation strengthens the claim.

How many RVUs is CPT code 15935 worth in 2025?

CPT 15935 has a total of 35.04 RVUs in 2025, consisting of 15.78 work RVUs, 16.37 practice expense RVUs (both facility and non-facility), and 2.89 malpractice RVUs. This high RVU value reflects the complexity and physician work involved in pressure ulcer excision with ostectomy and flap closure.

What is the global period for CPT 15935?

CPT 15935 has a 90-day global surgical period. This means all routine postoperative care for 90 days following the procedure is included in the reimbursement. Any unrelated E/M services during this period require modifier 24, and complications requiring return to OR require modifier 78. Planned staged procedures use modifier 58.

Can CPT 15935 be performed in an ASC setting?

Yes, CPT 15935 can be performed in an ASC (Ambulatory Surgical Center) setting, though it is more commonly performed in hospital inpatient settings due to patient complexity and comorbidities. The Medicare reimbursement rate is the same ($1133.42) for both facility and non-facility settings. ASC facility fees are separately reimbursed to the facility.