CPT 15952Surgery

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CPT code 15952 is used when a surgeon removes a pressure ulcer (bedsore) over the trochanter (hip bone prominence) and closes the wound using a flap of nearby tissue. This is a major surgical procedure requiring hospital admission and advanced wound reconstruction techniques.

Showing rates for

National Average

Base Medicare rate

$900.20

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

12.31

PE RVU (NF)

13.28

MP RVU

2.24

Total RVU

27.83

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

NCCI bundling edits

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Billing tips

Document the exact size and stage of the pressure ulcer before excision, including depth, bone involvement, and measurements in centimeters
Impact: Prevents downcoding to simpler repair codes (15920-15951) which reimburse $200-500 less
Clearly describe the flap type (advancement, rotation, muscle flap) and tissue origin in the operative report, as 15952 specifically requires flap closure versus primary closure
Impact: Distinguishes from CPT 15951 (primary closure without flap, $600-700 reimbursement) ensuring full $900.20 payment
Bill 15952 as the primary procedure when performed with other debridement or wound codes due to its high RVU value (27.83)
Impact: Prevents 50% reduction under multiple procedure rules, protecting $450+ in reimbursement
Separate billing for skin graft (15100-15101) is not appropriate when performed at the same site as flap closure; this is considered bundled
Impact: Avoids unbundling denials and potential fraud allegations; prevents audit penalties
For complex cases requiring osteomyelitis treatment, document bone excision separately but recognize that extensive debridement is included in 15952
Impact: Supports modifier 22 consideration for additional 20-50% reimbursement ($180-450 additional)
Verify global period (90 days) and avoid billing E/M services for routine postoperative care without modifier 24 for unrelated problems
Impact: Prevents denials of legitimate office visits and protects $100-300 per visit reimbursement

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 15952 in 2025?

The 2025 Medicare national average reimbursement for CPT 15952 is $900.20 for both facility and non-facility settings, based on 27.83 total RVUs and the 2025 conversion factor of 32.3465.

Can CPT 15952 be billed with debridement codes 11042-11047?

Generally no. Debridement is considered integral to the excision component of 15952. Billing separate debridement codes for the same anatomical site will typically result in bundling denials. Only debridement of distinct, separate ulcers or anatomically unrelated sites may be billed separately with modifier 59.

What is the difference between CPT 15952 and 15951?

CPT 15951 describes excision of a trochanteric pressure ulcer with primary closure (direct wound edge approximation), while 15952 involves flap closure (advancement, rotation, or muscle flap). Code 15952 has higher RVUs (27.83 vs approximately 20.00) and reimbursement due to increased surgical complexity of flap reconstruction.

How many RVUs is CPT code 15952 worth?

CPT 15952 has 27.83 total RVUs for 2025, consisting of 12.31 work RVUs, 13.28 practice expense RVUs (both facility and non-facility), and 2.24 malpractice RVUs.

What documentation is required to bill CPT 15952?

Required documentation includes pressure ulcer stage and measurements, specific trochanteric anatomical location, detailed description of flap type and tissue source, layer-by-layer closure technique, evidence of failed conservative treatment, and operative time. The operative report must clearly distinguish flap reconstruction from simple primary closure.

Can CPT 15952 be performed in an outpatient setting?

While CPT 15952 can technically be performed in an ambulatory surgery center or hospital outpatient department, it is most commonly performed as an inpatient procedure due to the complexity, patient comorbidities, and need for postoperative wound care and rehabilitation. Both facility and non-facility Medicare rates are $900.20 in 2025.

What diagnosis codes support medical necessity for CPT 15952?

ICD-10 codes L89.21x series (pressure ulcer of right/left hip) are primary diagnosis codes. Specifically, L89.213 (Stage 3) or L89.214 (Stage 4) trochanteric pressure ulcers support medical necessity. Additional codes for osteomyelitis (M86.x), paralysis, or immobility conditions strengthen documentation of medical necessity.