CPT 15958Surgery

Exc trchntr pr ulc prep ostc

CPT 15958 covers surgical removal of a pressure ulcer (bedsore) over the hip bone (trochanter), including cutting away damaged bone underneath. This is major reconstructive surgery performed when deep pressure sores expose or damage the bone itself.

Showing rates for

National Average

Base Medicare rate

$1,138.60

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

16.75

PE RVU (NF)

15.21

MP RVU

3.24

Total RVU

35.2

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

NCCI bundling edits

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Billing tips

Document specific bone involvement and ostectomy details including depth of bone removal, presence of osteomyelitis, and amount of bone debrided
Impact: Prevents downcoding to 11046 (debridement) which reimburses at only $358.50, a loss of $780.10 per case
Clearly distinguish this code from 15953 (sacral ulcer with ostectomy) - anatomic location must be specifically documented as trochanteric/hip region
Impact: 15953 has identical reimbursement but different anatomy; misidentification triggers audit flags and potential recoupment
Bill separately for muscle flap closure (15734-15738) if performed as a staged procedure with modifier 58, not during same operative session
Impact: Staged billing allows additional $1200-2500 in reimbursement; same-session billing typically bundles the closure
Obtain pre-authorization for all non-emergency cases as many payers classify this as prior-authorization-required due to high RVU value
Impact: Prevents 100% denial for lack of authorization; retroactive authorization rarely granted for elective cases
Photograph and document wound measurements (length, width, depth) and stage pre-operatively for medical necessity evidence
Impact: Reduces denial rate by 35-40% by providing visual evidence of medical necessity and complexity justifying high-value code
Code pathology findings of bone specimens separately (88305) as this provides additional revenue and supports medical necessity
Impact: Additional $80-120 in facility reimbursement and strengthens appeal cases if procedure necessity is questioned

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 15958 in 2025?

The 2025 Medicare national average reimbursement for CPT 15958 is $1138.60 for both facility and non-facility settings. This is based on a total RVU of 35.2 and the 2025 conversion factor of 32.3465. Actual payment may vary by geographic locality based on the GPCI adjustments in your area.

What is the difference between CPT 15958 and 15953?

CPT 15958 is for excision of a trochanteric pressure ulcer (over the hip bone) with ostectomy, while 15953 is for a sacral pressure ulcer (over the tailbone) with ostectomy. The procedures are identical in technique and reimbursement ($1138.60 each) but differ only in anatomic location. Accurate anatomic documentation is critical to selecting the correct code.

Can I bill CPT 15958 with a muscle flap closure code on the same day?

Generally, no. CPT 15958 represents preparation with ostectomy, while flap closure codes (15734-15738) are typically performed as staged procedures. If both are done same day, NCCI edits typically bundle them together. For separate reimbursement, the flap closure should be staged and billed with modifier 58 during the global period as a planned procedure.

What documentation is required to support medical necessity for CPT 15958?

Required documentation includes: pressure ulcer stage (typically IV), failed conservative treatment attempts with duration, wound measurements, evidence of bone exposure or osteomyelitis, pre-operative imaging if available, clear description of ostectomy performed, and medical justification for surgical intervention rather than continued conservative care.

How many RVUs is CPT code 15958 worth in 2025?

CPT 15958 has a total RVU value of 35.2 in 2025, consisting of 16.75 work RVUs, 15.21 practice expense RVUs (both facility and non-facility), and 3.24 malpractice RVUs. This high RVU value reflects the complexity and risk of performing ostectomy with pressure ulcer excision.

What modifier should I use for bilateral trochanteric pressure ulcers?

Use modifier 50 for bilateral procedures when trochanteric pressure ulcers on both hips are excised with ostectomy during the same operative session. Medicare typically reimburses bilateral procedures at 150% of the single procedure rate, resulting in approximately $1707.90 for both sides.

Why was my CPT 15958 claim denied and downcoded to debridement?

The most common reason for downcoding to debridement codes (11042-11047) is insufficient documentation of the ostectomy component. The operative report must clearly describe bone removal, preparation, or debridement. Without explicit documentation of bone work, payers assume only soft tissue debridement was performed, which is coded differently and reimburses at significantly lower rates.