No office rate
Both describe sacral pressure-ulcer excision with muscle-flap preparation. Choose 15937 when ostectomy is part of the procedure; 15936 is the option without that ostectomy distinction.
On this page
CMS RVU26D · Effective 2026-10-01
15936 Pressure ulcer excision Medicare reimbursement rates in Idaho
Reports excision of a sacral pressure ulcer with preparation of a muscle or myocutaneous flap for reconstruction, without the ostectomy described by a related code. Compare 15936 office and facility rates across CMS payment localities in Idaho.
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 15936 in Idaho?
Idaho 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
No supported rate
Facility setting
$760.78
1 of 1 localities have a supported rate.
Payment area: Idaho
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.
Pressure ulcer surgery
About 15936: Sacral ulcer excision with muscle flap preparation
Reports excision of a sacral pressure ulcer with preparation of a muscle or myocutaneous flap for reconstruction, without the ostectomy described by a related code.
This service involves removing a pressure ulcer from the sacral region and preparing a muscle or myocutaneous flap as part of reconstructive treatment. It is typically performed by a plastic or reconstructive surgeon in a hospital setting for a wound requiring more than primary closure or a skin flap. The operative report should make clear that the ulcer is sacral and that muscle-flap preparation was performed; the code distinguishes this approach from skin-flap closure and from procedures that include ostectomy.
Report the code for the documented sacral procedure, not simply because a muscle flap was considered or planned. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate. Medicare does not pay an assistant at surgery; co-surgeons require supporting documentation, and team surgery is not permitted.
CMS billing rules for 15936
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are 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 paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU12.83 · 51%
- Practice expense (office) RVU9.28 · 37%
- Malpractice RVU2.98 · 12%
631
Medicare services in 2024 · #3350 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.
15936 compared with similar codes
Office rates for Idaho, from the same CMS release.
No office rate
This code describes sacral ulcer excision with skin-flap closure. Choose 15936 when the operative work is preparation of a muscle or myocutaneous flap instead.
No office rate
15935 describes sacral ulcer excision with skin-flap closure and ostectomy. It differs from 15936 in both the flap approach and the ostectomy distinction.
No office rate
The flap-preparation approach is similar, but 15946 is for an ischial pressure ulcer. Use 15936 for the sacral site.
Compare 15936 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
Idaho →
Office / nonfacility
Unavailable
Facility
$760.78
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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 15936 in Idaho.
PPRRVU2026_Oct_nonQPP.csv
1,599
- Code
- 15936
- Physician work
- 12.83
- Practice expense
- 9.28
- Malpractice
- 2.98
GPCI2026.csv
47
- Locality
- Idaho
- Physician work
- 1.000
- Practice expense
- 0.920
- Malpractice
- 0.473
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 12.83 | × 1.000 | 12.8300 |
| Practice expense | 9.28 | × 0.920 | 8.5376 |
| Malpractice | 2.98 | × 0.473 | 1.4095 |
| Total RVUs | 22.7771 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Idaho$760.78
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 12.83 | 1 |
| Practice expense | 9.28 | 0.92 |
| Malpractice | 2.98 | 0.473 |
(12.83 × 1 + 9.28 × 0.92 + 2.98 × 0.473) × $33.4009 = $760.78
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.
15936 billing questions
How does this differ from 15934?
15936 is for sacral ulcer excision with preparation of a muscle or myocutaneous flap. Code 15934 describes sacral ulcer excision with skin-flap closure.
When is 15937 a better choice?
Use 15937 when the sacral pressure-ulcer procedure also includes ostectomy. Code 15936 describes muscle-flap preparation without that ostectomy distinction.
Can modifier 50 be used for a bilateral procedure?
No. The descriptor and anatomy make modifier 50 inappropriate for this code.
How are other procedures in the same session paid?
Under the standard multiple-procedure reduction, the highest-valued procedure is paid in full and other procedures are paid at 50% when performed in the same session.
What should the operative report document?
Document the sacral pressure-ulcer site, excision, and actual preparation of a muscle or myocutaneous flap. If ostectomy was performed, distinguish that work because 15937 describes the related sacral procedure with ostectomy.
Is an assistant or co-surgeon payable?
Medicare does not pay an assistant at surgery for this code. Co-surgeons are paid only with supporting documentation; team surgery is not permitted.
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.
1,59615933,,Exc sac pr ulc prim str ostc,A,,11.48,10.51,NA,10.51,,2.65,24.64,24.64,0,090,0.10,0.71,0.19,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,59715934,,Exc sacral pr ulc skn flap,A,,13.34,10.78,NA,10.78,,2.48,26.60,26.60,0,090,0.10,0.71,0.19,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,59815935,,Exc sac pr ulc skn flp ostc,A,,15.39,13.04,NA,13.04,,2.86,31.29,31.29,0,090,0.10,0.71,0.19,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,59915936,,Exc sac pr ulc prep mus flap,A,,12.83,9.28,NA,9.28,,2.98,25.09,25.09,0,090,0.10,0.71,0.19,2,0,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,60015937,,Exc sac pr ulc prep mus ostc,A,,14.76,10.05,NA,10.05,,2.72,27.53,27.53,0,090,0.10,0.71,0.19,2,0,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,60115940,,Exc ischial pr ulc prim sutr,A,,9.95,7.67,NA,7.67,,2.27,19.89,19.89,0,090,0.10,0.71,0.19,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,60215941,,Exc isch pr ulc prm sut ostc,A,,12.10,11.58,NA,11.58,,2.25,25.93,25.93,0,090,0.10,0.71,0.19,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4410212,GA,01,ATLANTA,1.003,1.016,1.201
4510212,GA,99,REST OF GEORGIA,1.000,0.892,1.192
4601212,HI,01,"HAWAII, GUAM",1.000,1.137,0.579
4702202,ID,00,IDAHO,1.000,0.920,0.473
4806102,IL,16,CHICAGO,1.007,1.005,2.295
4906102,IL,12,EAST ST. LOUIS,1.000,0.920,2.014
5006102,IL,15,SUBURBAN CHICAGO,1.007,1.027,1.772