CPT 15941Surgery

Exc isch pr ulc prm sut ostc

CPT code 15941 covers the surgical removal of a pressure ulcer (bedsore) on the ischium (sitting bone) that includes removing damaged bone tissue beneath the wound. This is a complex reconstructive procedure typically performed on patients with deep, chronic pressure sores.

Showing rates for

National Average

Base Medicare rate

$930.29

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

12.41

PE RVU (NF)

14.08

MP RVU

2.27

Total RVU

28.76

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

NCCI bundling edits

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Billing tips

Document the exact depth and stage of the pressure ulcer with bone involvement clearly stated in operative notes
Impact: Prevents downcoding to simpler debridement codes (11044-11047) which reimburse $100-300 less; ensures full $930.29 payment
Separately document and code ostectomy extent - specify cubic centimeters or grams of bone removed
Impact: Justifies 15941 over 15940 (without ostectomy, pays approximately $200 less); strengthens medical necessity documentation
Verify global period (90 days) before billing related wound care or E/M services during postoperative period
Impact: Prevents automatic denials for services included in global package; saves appeal time and reduces claim rejection rate by 40%
When billing bilaterally, use modifier 50 or LT/RT appropriately - do not bill 15941 twice without modifiers
Impact: Bilateral procedures with modifier 50 typically reimburse at 150% ($1,395.44) versus risk of duplicate claim denial
Coordinate with facility coding to ensure ICD-10 codes match procedure (L89.3xx series for ischial ulcers with appropriate stage and laterality)
Impact: Mismatched diagnosis codes result in 25-30% medical necessity denials; proper coordination reduces denial rate
Submit surgical pathology report showing bone specimen when available to support ostectomy component
Impact: Reduces audit risk by 60%; provides objective evidence for ostectomy component differentiating from soft tissue-only procedures

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 15941 in 2025?

The 2025 Medicare national average reimbursement for CPT 15941 is $930.29 for both facility and non-facility settings, based on 28.76 total RVUs and a conversion factor of 32.3465.

What is the difference between CPT 15941 and 15940?

CPT 15941 includes ostectomy (bone removal) as part of the ischial pressure ulcer excision, while 15940 is excision with primary closure but without ostectomy. Code 15941 should only be used when bone is actually removed and documented in the operative note and pathology report.

Can CPT 15941 be billed bilaterally?

Yes, if bilateral ischial pressure ulcers are excised with ostectomy during the same operative session, use modifier 50 for bilateral procedure or report the code twice with LT and RT modifiers, depending on payer preference. Bilateral billing typically reimburses at 150% of the single procedure rate.

What diagnosis codes support medical necessity for CPT 15941?

ICD-10 codes L89.3xx (pressure ulcer of buttock) with appropriate stage indicators (3 for stage III, 4 for stage IV) support medical necessity. Also include codes for osteomyelitis (M86.x), paralysis/immobility conditions, and relevant comorbidities that contribute to pressure ulcer development.

How many RVUs is CPT code 15941 worth?

CPT 15941 has 28.76 total RVUs for 2025, consisting of 12.41 work RVUs, 14.08 practice expense RVUs (both facility and non-facility), and 2.27 malpractice RVUs.

Can I bill CPT 15941 with a skin graft or flap closure?

CPT 15941 specifically describes primary suture closure. If a skin graft or flap is required, you should use different codes (15933-15937 for sacral/ischial with flap, or 15920-15922 for excision without ostectomy plus separate flap codes). Billing both may result in bundling denials unless distinct procedures are clearly documented.

What is the global period for CPT 15941?

CPT 15941 has a 90-day global surgical period. All routine postoperative care, including wound checks, suture removal, and uncomplicated follow-up visits, are included in the reimbursement and cannot be billed separately during this period.