Billing code 11042: Wound debridementMedicare rate & RVUs in Washington
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.
Medicare pays $137.05–$155.13 for 11042 in the office in Washington, from Rest Of Washington to Seattle (King Cnty). Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 9 sections
What 11042 covers
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.
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.
Where 11042 pays more and less in Washington
| Payment locality | Office | Facility |
|---|---|---|
| Rest Of Washington | $137.05 | $56.16 |
| Seattle (King Cnty) | $155.13 | $60.87 |
How the 11042 rate is calculated
Each of 11042’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 11042
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 0.98Practice expense 2.86Malpractice 0.13
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 11042
The CMS indicators that decide how 11042 is paid alongside other services.
CMS payment indicators · 11042
Wound debridement
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
11042 without 51 · national office
$132.60
Wound debridement
11042-51 · Second procedure: 50%
$66.30
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
11042 compared with similar codes
Compare codes
11042 vs 97597 vs 11043 vs 11045 vs 11044: national Medicare rates
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How to choose
- 97597Selective wound debridement
- 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.
- 11043Wound debridement
- 11043 requires documented removal of muscle and/or fascia. If tissue removal stops in the subcutaneous layer, even in a deeper wound, 11042 applies.
- 11045Wound debridement
- 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.
- 11044Wound debridement
- Choose 11044 when bone is debrided. A wound that exposes bone still falls under 11042 if subcutaneous tissue is the deepest tissue actually removed.
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 indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
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