$100.60
Choose 97597 for selective wound debridement when subcutaneous tissue is not removed. Report 11042 when subcutaneous tissue is actually excised, even if both wounds extend to that depth.
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CMS RVU26D · Effective 2026-10-01
11042 Wound debridement Medicare reimbursement rates in Delaware
Report this code when subcutaneous tissue is removed from a wound and the total area debrided to that depth is 20 square centimeters or less. Compare 11042 office and facility rates across CMS payment localities in Delaware.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 11042 in Delaware?
Delaware has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
$131.18
1 of 1 localities have a supported rate.
Payment area: Delaware
One mapped payment locality.
Facility setting
$55.28
1 of 1 localities have a supported rate.
Payment area: Delaware
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Wound care procedure
About 11042: Subcutaneous tissue debridement, first 20 sq cm
Report this code when subcutaneous tissue is removed from a wound and the total area debrided to that depth is 20 square centimeters or less.
Clinicians remove nonviable subcutaneous tissue from an open wound, sometimes taking overlying skin, using a scalpel, scissors, curette, or forceps. Podiatrists, wound care clinicians, surgeons, and qualified nonphysician practitioners perform this work in offices, outpatient wound centers, and hospitals. Typical wounds include diabetic foot ulcers, pressure injuries, venous leg ulcers, and dehisced surgical incisions. The code depends on subcutaneous tissue actually removed, not simply exposed by the wound.
Report 11042 for the first 20 sq cm or less debrided to subcutaneous depth; add 11045 for each additional 20 sq cm or part thereof. Sum debrided areas of separate wounds at this depth, but size wounds debrided to muscle or bone separately. Record each wound's location, debrided area, tissue removed, instrument, and deepest tissue level removed. The 0-day global period includes routine same-day preoperative and postoperative care. Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and other procedures performed in the same session at 50%. Modifier 50 is inappropriate; assistant-at-surgery payment is statutorily restricted, and co-surgeons and team surgery are not permitted.
CMS billing rules for 11042
- Global period
- Minor procedure with a 0-day global period: same-day preoperative and postoperative care is included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- Assistant at surgery
- Statutory restriction: assistant at surgery is not paid.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU0.98 · 25%
- Practice expense (office) RVU2.86 · 72%
- Malpractice RVU0.13 · 3%
2M
Medicare services in 2024 · #80 by national volume
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
11042 compared with similar codes
Office rates for Delaware, from the same CMS release.
$236.86
11043 requires documented removal of muscle and/or fascia. If tissue removal stops in the subcutaneous layer, even in a deeper wound, 11042 applies.
$41.32
11045 is an add-on covering each additional 20 sq cm or part thereof debrided to subcutaneous depth; 11042 covers the first 20 sq cm.
$317.17
Choose 11044 when bone is debrided. A wound that exposes bone still falls under 11042 if subcutaneous tissue is the deepest tissue actually removed.
Compare 11042 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Delaware →
Office / nonfacility
$131.18
Facility
$55.28
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 11042 in Delaware.
PPRRVU2026_Oct_nonQPP.csv
1,255
- Code
- 11042
- Physician work
- 0.98
- Practice expense
- 2.86
- Malpractice
- 0.13
GPCI2026.csv
40
- Locality
- Delaware
- Physician work
- 1.005
- Practice expense
- 0.988
- Malpractice
- 0.899
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.98 | × 1.005 | 0.9849 |
| Practice expense | 2.86 | × 0.988 | 2.8257 |
| Malpractice | 0.13 | × 0.899 | 0.1169 |
| Total RVUs | 3.9274 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Delaware$131.18
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0.98 | 1.005 |
| Practice expense | 2.86 | 0.988 |
| Malpractice | 0.13 | 0.899 |
(0.98 × 1.005 + 2.86 × 0.988 + 0.13 × 0.899) × $33.4009 = $131.18
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0.98 | 1.005 |
| Practice expense | 0.56 | 0.988 |
| Malpractice | 0.13 | 0.899 |
(0.98 × 1.005 + 0.56 × 0.988 + 0.13 × 0.899) × $33.4009 = $55.28
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
11042 billing questions
How do I code two ulcers debrided to subcutaneous tissue on the same day?
Add the areas actually debrided to subcutaneous depth. Report 11042 for the first 20 sq cm and 11045 for each additional 20 sq cm or portion of the combined area.
What if one wound is debrided to subcutaneous tissue and another to muscle?
Do not combine areas across depths. Report 11042 for the subcutaneous wound and 11043 for the wound with muscle or fascia removed, sizing each separately.
Can selective debridement codes 97597 or 97598 be billed for the same wound?
Do not report selective debridement for the same wound when subcutaneous tissue is excised and reported with 11042. Selective debridement may be appropriate when subcutaneous tissue is not removed.
Can an E/M visit be billed on the same day?
A significant, separately identifiable E/M service beyond routine care associated with the debridement may be reported with modifier 25. Routine same-day preoperative and postoperative care is included in the 0-day global period.
Should modifier 50 be used for wounds on both feet?
No. Total the areas debrided to subcutaneous depth on both feet; report 11042 for the first 20 sq cm and 11045 for additional area.
What documentation best supports this code?
Record the location and area actually debrided for each wound, the instrument used, and removal of subcutaneous tissue. A wound extending into fat, or documentation of slough or eschar removal alone, does not establish that subcutaneous tissue was removed.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
1,2521101T,,Tc spi neuromd appl each 15,C,,0.00,0.00,,0.00,,0.00,0.00,0.00,0,YYY,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,2531102T,,Ntrop molec asmt lng tum tis,C,,0.00,0.00,,0.00,,0.00,0.00,0.00,0,ZZZ,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,2541103T,,Ntrop molec asmt ov tub/prtl,C,,0.00,0.00,,0.00,,0.00,0.00,0.00,0,ZZZ,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,25511042,,Dbrdmt subq tis 1st 20sqcm/<,A,,0.98,2.86,,0.56,,0.13,3.97,1.67,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,25611043,,Dbrdmt musc&/fsca 1st 20/<,A,,2.63,4.12,,1.09,,0.42,7.17,4.14,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,25711044,,Dbrdmt bone 1st 20 sq cm/<,A,,4.00,4.96,,1.38,,0.64,9.60,6.02,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,25811045,,Dbrdmt subq tiss each addl,A,,0.49,0.69,,0.10,,0.07,1.25,0.66,0,ZZZ,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3704112,CO,01,COLORADO,1.012,1.064,0.781
3813102,CT,00,CONNECTICUT,1.020,1.077,1.210
3912202,DC,01,DC + MD/VA SUBURBS,1.054,1.178,1.113
4012102,DE,01,DELAWARE,1.005,0.988,0.899
4109102,FL,03,FORT LAUDERDALE,1.000,1.013,1.808
4209102,FL,04,MIAMI,1.000,1.041,2.529
4309102,FL,99,REST OF FLORIDA,1.000,0.956,1.503