CPT 15940Surgery

Exc ischial pr ulc prim sutr

CPT code 15940 covers the surgical removal of a pressure sore (bedsore) on the ischial area (the bony part you sit on) and closing the wound with stitches. This is a primary closure procedure performed after removing damaged tissue.

Showing rates for

National Average

Base Medicare rate

$698.04

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

10.2

PE RVU (NF)

9.17

MP RVU

2.21

Total RVU

21.58

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

NCCI bundling edits

Loading bundling edits…

Billing tips

Document pressure ulcer stage (III or IV) and dimensions (length, width, depth in cm) in preoperative assessment to justify surgical intervention versus conservative management
Impact: Prevents medical necessity denials which account for 35-40% of claim rejections for this code; proper staging documentation supports the $698.04 reimbursement
Clearly differentiate 15940 from codes requiring flap or graft coverage (15941, 15946) by documenting that primary closure was achieved without tension and without need for advancement flaps
Impact: Prevents upcoding allegations and ensures correct code selection; billing 15941 instead when flap is used increases reimbursement to approximately $1,200-1,400
When performing concurrent procedures on multiple pressure ulcer sites, append modifier 59 or use distinct anatomical modifiers to prevent bundling with other excision codes
Impact: Can add $698.04 per additional distinct site when properly documented; without modifier 59, secondary procedures may be denied as incidental
For unusually complex cases requiring extensive debridement beyond typical scope, append modifier 22 with detailed operative note documenting additional 50%+ time and complexity factors
Impact: Potential additional reimbursement of $140-350 (20-50% increase) when properly supported; requires comparison of actual operative time versus typical 90-120 minutes
Verify global period (90 days for 15940) and do not separately bill E/M services or minor wound care during this period unless truly unrelated (modifier 24/25)
Impact: Prevents automatic denials of postoperative care; E/M services during global period typically denied unless modifier 24 used with appropriate documentation

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 15940?

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 code 15940 in 2025?

The 2025 Medicare national average reimbursement for CPT 15940 is $698.04 for both facility and non-facility settings. This rate is based on 21.58 total RVUs multiplied by the 2025 conversion factor of 32.3465. Actual reimbursement may vary by geographic locality based on GPCI adjustments.

What is the difference between CPT 15940 and 15941?

CPT 15940 is for excision of an ischial pressure ulcer with primary suture closure (direct closure with stitches), while 15941 involves excision with ostectomy (bone removal) of the ischial tuberosity. Code 15941 represents a more extensive procedure requiring bone resection and typically reimburses at a higher rate. Proper documentation of whether bone was removed is critical for correct code selection.

Can CPT 15940 be billed bilaterally?

Yes, CPT 15940 can be billed bilaterally when ischial pressure ulcers are excised on both sides during the same operative session. Use modifier 50 for bilateral procedures, which typically results in 150% reimbursement (100% for the first side and 50% for the second). Alternatively, some payers prefer reporting with RT/LT modifiers on separate lines.

What stage pressure ulcer is appropriate for CPT 15940?

CPT 15940 is typically appropriate for Stage III or Stage IV pressure ulcers that involve full-thickness tissue loss requiring surgical excision. Stage I and II ulcers are generally managed conservatively without surgical excision. Documentation must clearly indicate the stage and justify why surgical intervention was medically necessary after conservative measures failed.

How many RVUs is CPT code 15940 worth in 2025?

CPT 15940 has 21.58 total RVUs in 2025, comprised of 10.2 work RVUs, 9.17 practice expense RVUs, and 2.21 malpractice RVUs. These are the same for both facility and non-facility settings. The high work RVU reflects the complexity and time required for surgical excision and primary closure of ischial pressure ulcers.

What is the global period for CPT 15940?

CPT 15940 has a 90-day global period, meaning all routine postoperative care for 90 days following the procedure is included in the reimbursement and cannot be billed separately. E/M services during this period are only separately billable if unrelated to the surgery (modifier 24) or if addressing a complication requiring return to the OR (modifier 78).

Can debridement codes be billed with CPT 15940?

Debridement codes (11042-11047) are typically bundled into CPT 15940 when performed on the same date of service at the same anatomical site, as debridement is considered an integral component of the excision procedure. Separate billing usually results in denial per NCCI edits. Only if debridement is performed at a completely separate site or during a distinct prior session would separate billing be appropriate.