Billing code 15946: Pressure ulcer surgeryMedicare rate & RVUs in Washington
Reports excision of an ischial pressure ulcer with preparation of a muscle or myocutaneous flap for reconstruction of the defect.
CMS doesn’t publish an office rate for 15946 in Washington.
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 15946 covers
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.
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 15946 pays more and less in Washington
| Payment locality | Office | Facility |
|---|---|---|
| Rest Of Washington | Unavailable | $1,459.02 |
| Seattle (King Cnty) | Unavailable | $1,586.30 |
How the 15946 rate is calculated
Each of 15946’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 · 15946
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 23.52Practice expense 15.33Malpractice 4.88
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 15946
15946 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 15946
Pressure ulcer surgery
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are 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) | 1 | Permitted with supporting documentation. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.10/0.71/0.19 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 15946
Pressure ulcer surgery
90-day global period ends
Dec 30, 2026
Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).
Visit on Oct 31, 2026
Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
15946 without 51 · national facility
$1,460.62
Pressure ulcer surgery
15946-51 · Second procedure: 50%
$730.31
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%).
15946 compared with similar codes
Compare codes
15946 vs 15944 vs 15945 vs 15936: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 15944Pressure ulcer excision
- Both address an ischial pressure ulcer, but 15944 describes skin-flap closure. Use 15946 when the documented reconstruction involves a muscle or myocutaneous flap.
- 15945Skin flap closure
- 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.
- 15936Pressure ulcer excision
- The flap approach is similar, but 15936 is for a sacral pressure ulcer. Use 15946 for the ischial site.
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 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
Show the CMS file lines behind this rate
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