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CMS RVU26D · Effective 2026-10-01

15946 Pressure ulcer surgery Medicare reimbursement rates in Indiana

Reports excision of an ischial pressure ulcer with preparation of a muscle or myocutaneous flap for reconstruction of the defect. Compare 15946 office and facility rates across CMS payment localities in Indiana.

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 15946 in Indiana?

Indiana 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

$1339.46

1 of 1 localities have a supported rate.

Payment area: Indiana

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.

Find 15946 in your payment locality →

Pressure ulcer surgery

About 15946: Ischial pressure ulcer excision with muscle flap

Reports excision of an ischial pressure ulcer with preparation of a muscle or myocutaneous flap for reconstruction of the defect.

This operation treats a pressure wound over the ischial region when reconstruction requires a muscle or myocutaneous flap. A reconstructive or plastic surgeon typically performs it in an operating room, often for a deep, chronic wound in a patient with limited mobility. The operative report should identify the ischial site, describe ulcer excision, and document preparation of the muscle or myocutaneous flap; wound depth alone does not establish the flap method.

Report the code for the documented ischial procedure and flap approach, rather than a skin-flap or primary-closure code. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur in the same session, the highest-valued is paid in full and other procedures are subject to the standard 50% multiple-procedure 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 15946

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 RVU23.52 · 54%
  • Practice expense (office) RVU15.33 · 35%
  • Malpractice RVU4.88 · 11%

988

Medicare services in 2024 · #2979 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.

15946 compared with similar codes

Office rates for Indiana, from the same CMS release.

15944

Pressure ulcer excision

Ischial site, skin flap closure

No office rate

Both address an ischial pressure ulcer, but 15944 describes skin-flap closure. Use 15946 when the documented reconstruction involves a muscle or myocutaneous flap.

15945

Skin flap closure

Ischial ulcer with ostectomy

No office rate

This code describes an ischial skin-flap procedure with ostectomy. Distinguish it from 15946 by the flap type and whether the operative service includes ostectomy.

15936

Pressure ulcer excision

Sacral, muscle flap preparation

No office rate

The flap approach is similar, but 15936 is for a sacral pressure ulcer. Use 15946 for the ischial site.

Compare 15946 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

Office and facility base rates · shared scale starting at $0

  • Indiana →

    Office / nonfacility

    Unavailable

    Facility

    $1339.46

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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 15946 in Indiana.

PPRRVU2026_Oct_nonQPP.csv

1,605

Code
15946
Physician work
23.52
Practice expense
15.33
Malpractice
4.88

GPCI2026.csv

52

Locality
Indiana
Physician work
1.000
Practice expense
0.927
Malpractice
0.486
Facility calculation for 15946 in Indiana
ComponentRVULocality factorAdjusted
Physician work23.52× 1.00023.5200
Practice expense15.33× 0.92714.2109
Malpractice4.88× 0.4862.3717
Total RVUs40.1026
Conversion factor× 33.4009

Facility rate, Indiana$1339.46

Explore RVUs, geographic factors and the full formula

Facility

Facility calculation inputs
ComponentRVULocal GPCI
Work23.521
Practice expense15.330.927
Malpractice4.880.486

(23.52 × 1 + 15.33 × 0.927 + 4.88 × 0.486) × $33.4009 = $1339.46

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.

15946 billing questions

How does this differ from the ischial skin-flap code?

Choose this code when the operative report documents preparation of a muscle or myocutaneous flap. The skin-flap code describes reconstruction using a skin flap instead.

Is ulcer excision reported separately?

The code encompasses the ischial ulcer excision with preparation of the specified flap. Do not separately report the excision as though it were an independent procedure.

Does this code include an ostectomy?

The code selection distinguishes procedures that include ostectomy from those that do not. Use the operative report to determine whether bone was removed and select the corresponding code.

Can modifier 50 be used for ulcers on both sides?

No. CMS identifies bilateral adjustment as inappropriate for this code; modifier 50 is not the way to report bilateral anatomy.

How does the global period affect postoperative visits?

The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.

Can an assistant or co-surgeon be reported?

Medicare does not pay an assistant at surgery for this code. Co-surgeons are payable 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.

RVUs for 15946PPRRVU2026_Oct_nonQPP.csv, line 1,605 (RVU26D)
Geographic factors for IndianaGPCI2026.csv, line 52 (RVU26D)
Open CMS sourceHow this rate is calculatedBuild a fee sheet