CPT 15945Surgery

Exc isch pr ulc skn flp ostc

CPT 15945 covers the surgical removal of a pressure ulcer (bedsore) over the ischial bone (sit bone) along with closure using a skin flap taken from nearby tissue. This is a complex reconstructive procedure typically performed on patients who have developed deep pressure wounds from prolonged sitting or bedrest.

Showing rates for

National Average

Base Medicare rate

$1,001.12

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

13.75

PE RVU (NF)

14.7

MP RVU

2.5

Total RVU

30.95

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

NCCI bundling edits

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Billing tips

Document ulcer staging (III or IV) using NPUAP classification and dimensions (length, width, depth in cm) in operative report
Impact: Medical necessity documentation prevents 40-60% of denials; undocumented staging is primary denial reason costing practices the full $1001.12
Separately document and photograph failed conservative management (minimum 30 days wound care, pressure relief, nutritional optimization) in medical record prior to surgery
Impact: Medicare requires conservative treatment failure documentation; lack of this causes denials in approximately 30% of cases
Specify exact flap type (advancement, rotation, transposition) and dimensions in operative note as generic 'flap closure' may trigger downcoding to simple repair codes worth $200-400 less
Impact: Prevents downcoding to CPT 15936 (simpler repair); maintains full $1001.12 reimbursement versus potential $600-800 reduction
Code ostectomy separately only if extensive bone resection beyond ulcer base is performed; routine ostectomy is bundled into 15945
Impact: Unbundling ostectomy inappropriately triggers audits; however, extensive bone resection requiring separate approach may justify additional CPT 15946 (+$339 Medicare)
Bill only once per operative session even if bilateral ischial ulcers are repaired; use modifier 50 or LT/RT with two units only if payer-specific policy allows
Impact: Most payers bundle bilateral repairs into single payment; inappropriate billing of two units may result in recoupment of $1001.12
Verify global period (90 days) and avoid billing separately for routine postoperative wound care, suture removal, or office visits unless unrelated E/M service with modifier 24

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 15945 in 2025?

The 2025 Medicare national average reimbursement for CPT 15945 is $1001.12 for both facility and non-facility settings. This rate is based on 30.95 total RVUs (13.75 work RVU, 14.7 practice expense RVU, 2.5 malpractice RVU) multiplied by the 2025 conversion factor of 32.3465. Actual payment may vary based on geographic location and local Medicare Administrative Contractor adjustments.

Can CPT 15945 and 15946 be billed together?

CPT 15945 and 15946 should not typically be billed together for the same ischial ulcer. Code 15945 includes routine ostectomy as part of the ulcer excision. Use 15946 only when extensive separate bone resection beyond the ulcer base is required, typically involving significant ischial tuberosity reconstruction requiring a separate surgical approach. Documentation must clearly support the additional work to avoid bundling denials.

What documentation is required to prove medical necessity for CPT 15945?

Medical necessity requires documentation of: (1) Stage III or IV pressure ulcer with NPUAP staging criteria, (2) minimum 30 days of failed conservative management including wound care, pressure relief, and nutritional support, (3) ulcer dimensions and photographic evidence, (4) functional impairment or infection risk, and (5) patient is appropriate surgical candidate. Without this documentation, expect denials for lack of medical necessity.

What is the global period for CPT 15945?

CPT 15945 has a 90-day global period. This means all routine postoperative care including wound checks, suture removal, and follow-up visits related to the surgery are included in the $1001.12 reimbursement. Separate E/M services during this period require modifier 24 and must be for unrelated conditions. Complications requiring return to OR use modifier 78 with reduced payment.

How do you code bilateral ischial pressure ulcer repairs?

Bilateral ischial ulcer repairs performed during the same operative session are typically bundled by most payers into a single unit of CPT 15945. Some payers may accept modifier 50 (bilateral procedure) or reporting with LT/RT modifiers and two units, but verify payer-specific policy. Medicare generally reimburses bilateral procedures at 150% rather than 200%, so expected payment would be approximately $1501.68 rather than $2002.24.

What are the most common denial reasons for CPT 15945?

The most common denials are: (1) insufficient documentation of conservative treatment failure (30-40% of denials), (2) lack of appropriate ulcer staging documentation (20-25% of denials), (3) downcoding to simpler repair codes due to inadequate operative report detail (15-20% of denials), and (4) bundling with debridement or other wound codes billed same session (10-15% of denials). Proper documentation prevents most denials.

What modifiers are most commonly used with CPT 15945?

The most applicable modifiers are: modifier 22 for significantly increased complexity/work (requires detailed documentation for 20-50% payment increase), modifier 58 for staged procedures during global period, modifier 59 for distinct procedures at different anatomic sites, modifier 78 for return to OR during postoperative period (reduces payment to ~70%), and LT/RT for anatomic specification. Modifier 50 for bilateral procedures has limited acceptance by payers for ischial ulcers.