CPT 15950Surgery

Exc trchntr pr ulc prim sutr

CPT code 15950 covers the surgical removal of a pressure ulcer (bedsore) located on the trochanter (the bony prominence on the upper thigh bone) and closing the wound with stitches. This is a primary closure procedure for treating stage III or IV pressure injuries in this specific anatomical location.

Showing rates for

National Average

Base Medicare rate

$626.55

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

8.03

PE RVU (NF)

9.87

MP RVU

1.47

Total RVU

19.37

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

NCCI bundling edits

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Billing tips

Document exact ulcer staging (III or IV) with dimensions in centimeters and depth to anatomical structures in operative note
Impact: Prevents 30-40% of denials related to medical necessity; ensures proper code selection over simple debridement codes that pay $200-300 less
Clearly differentiate this code from 15920-15999 series by specifying trochanteric location and primary suture technique versus flap or graft
Impact: Prevents downcoding to lower-paying debridement codes (11042-11047 range, $50-$350) or upcoding denials for more complex reconstruction codes
Bill on same claim as any bone debridement/resection (11044) if osteomyelitis is present and separately documented
Impact: Can add $200-400 in additional reimbursement when medically necessary and properly documented as distinct from soft tissue excision
Verify that primary closure was achieved without tension and document any undermining or layered closure techniques used
Impact: Supports medical necessity and prevents denials questioning why simpler debridement or more complex flap reconstruction wasn't coded instead
For Medicare patients, ensure hospital status (inpatient vs outpatient) is correctly reflected as both facility and non-facility rates are identical at $626.55
Impact: While rates are equal, incorrect place of service coding can trigger audit flags and payment delays
When performed during same encounter as other ulcer excisions (sacral, ischial), use modifier 59 on secondary codes and document separate incisions/sites
Secures payment for multiple ulcer excisions that might otherwise be bundled; can add $600+ per additional site when properly documented

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Frequently asked questions

What is the Medicare reimbursement rate for CPT code 15950 in 2025?

The 2025 Medicare national average reimbursement for CPT 15950 is $626.55 for both facility and non-facility settings. This is calculated using the total RVU of 19.37 multiplied by the 2025 conversion factor of 32.3465. Actual payment may vary based on geographic locality adjustments.

What is the difference between CPT 15950 and simple debridement codes?

CPT 15950 involves complete excision of a trochanteric pressure ulcer with primary suture closure, removing the entire ulcer down to healthy tissue and closing with stitches. Simple debridement codes (11042-11047) only involve removal of dead tissue without excision of the ulcer itself and without closure. The documentation must clearly show excision with margins and primary approximation of wound edges to justify 15950.

Can CPT 15950 be billed bilaterally with modifier 50?

Yes, modifier 50 can be appended when bilateral trochanteric pressure ulcers are excised and closed during the same operative session. This would increase reimbursement to 150% of the base rate ($939.83 for Medicare). However, documentation must clearly support the presence of distinct ulcers on both right and left trochanters requiring separate excision and closure.

What documentation is required to avoid denials for CPT 15950?

Critical documentation includes: specific trochanteric location with laterality, ulcer staging (III or IV), precise dimensions in centimeters, description of complete excision to healthy tissue margins, detailed primary suture closure technique, evidence of failed conservative treatment, and any bone involvement. Operative notes must clearly differentiate this from simple debridement and explain why primary closure was appropriate versus flap reconstruction.

How many RVUs is CPT code 15950 worth in 2025?

CPT 15950 has a total RVU value of 19.37 in 2025, consisting of 8.03 work RVUs, 9.87 practice expense RVUs (both facility and non-facility), and 1.47 malpractice RVUs. This is a relatively high RVU value reflecting the surgical complexity and time required for pressure ulcer excision with closure.

Can CPT 15950 be billed with other pressure ulcer excision codes on the same date?

Yes, 15950 can be billed with other pressure ulcer excision codes (such as 15920 for sacral or 15940 for ischial ulcers) when performed at distinctly separate anatomical sites during the same operative session. Modifier 59 should be appended to the secondary procedure code, and documentation must clearly describe separate incisions, distinct locations, and independent medical necessity for each excision.

What are common reasons for CPT 15950 claim denials?

The most common denials include: insufficient documentation of medical necessity or failed conservative treatment, downcoding to debridement codes due to unclear closure documentation, bundling denials when billed with other wound procedures without appropriate modifiers, and denials during global periods when the procedure is related to complications. Each requires specific documentation and appeal strategies to overturn.