CPT 15944Surgery

Exc isch pr ulc skn flp clsr

CPT code 15944 covers surgical removal of a pressure ulcer (bedsore) on the ischial area (buttocks/sitting bones) along with closure of the wound using a skin flap taken from nearby tissue.

Showing rates for

National Average

Base Medicare rate

$917.67

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

12.44

PE RVU (NF)

13.65

MP RVU

2.28

Total RVU

28.37

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

NCCI bundling edits

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Billing tips

Document pressure ulcer stage using NPUAP/NPIAP staging system in both pre-operative assessment and operative report
Impact: Stage III-IV documentation essential for medical necessity; absence causes 60-70% of initial denials worth $917.67
Clearly describe flap type (advancement, rotation, transposition) and dimensions in operative report to differentiate from simple closure codes
Impact: Prevents downcoding to 15933-15937 (lower complexity codes worth $200-400 less)
Document failed conservative treatment attempts (duration, modalities, wound measurements) in pre-operative notes
Impact: Medicare requires proof of 30+ days failed conservative care; missing documentation results in medical necessity denials
Bill 15944 only once per ischial site regardless of flap complexity; multiple flaps on same ulcer are included
Impact: Prevents unbundling denials and potential fraud investigation; no additional payment for multiple flaps on single ulcer
Separate debridement codes (11042-11047) are generally bundled unless performed on distinct separate wounds
Impact: Avoid $75-200 in denials by only billing debridement separately when anatomically distinct from flap site
Ensure facility vs non-facility setting is correctly designated; this code typically performed inpatient
Impact: Both settings reimburse $917.67 for this code, but incorrect setting causes claim rejection and payment delays

Common denials

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Frequently asked questions

What is the Medicare reimbursement rate for CPT code 15944 in 2025?

The 2025 Medicare national average reimbursement for CPT 15944 is $917.67 for both facility and non-facility settings, based on 28.37 total RVUs (12.44 work + 13.65 PE + 2.28 MP) multiplied by the conversion factor of 32.3465.

What stage pressure ulcer is required to bill CPT code 15944?

CPT 15944 is typically appropriate for stage III or stage IV ischial pressure ulcers that involve subcutaneous tissue or deeper structures and require excision with flap closure. Stage I-II ulcers generally do not meet medical necessity criteria for this extensive surgical intervention.

Can CPT 15944 be billed with debridement codes on the same date?

Generally no, debridement is considered bundled into 15944 when performed on the same ischial ulcer. However, debridement codes (11042-11047) may be separately billable with modifier 59 if performed on anatomically distinct, separate pressure ulcers at different body locations during the same operative session.

How is CPT 15944 different from CPT 15946?

CPT 15944 covers excision of ischial pressure ulcer with skin flap closure, while 15946 involves ostectomy (removal of underlying bone, typically part of the ischial tuberosity) in addition to ulcer excision and flap closure. Code 15946 represents a more extensive procedure with higher reimbursement and is used when bone removal is medically necessary.

What documentation proves medical necessity for CPT 15944?

Medical necessity requires documentation of stage III-IV pressure ulcer with specific dimensions, structures involved, failed conservative treatment for at least 30 days (offloading, wound care, nutritional support), patient's inability to heal with conservative measures, and absence of conditions preventing surgical healing. Photographs and wound culture results strengthen medical necessity.

How do you bill CPT 15944 for bilateral ischial pressure ulcers?

For bilateral ischial pressure ulcers excised with flap closure during the same operative session, bill CPT 15944 once with modifier 50 (bilateral procedure). This typically results in 150% of the base rate reimbursement. Do not bill 15944 twice on separate lines as this will result in claim denial.

What are common reasons for CPT 15944 claim denials?

The most common denials include: insufficient documentation of pressure ulcer stage/severity, lack of evidence showing failed conservative treatment, inadequate operative report detail distinguishing flap closure from simple closure, bundling issues with separately billed debridement on same site, and missing medical necessity justification for surgical intervention.