Billing code 15958: Pressure ulcer surgeryMedicare rate & RVUs in Washington
Reports excision of a trochanteric pressure ulcer with underlying bone removal and muscle or myocutaneous flap coverage.
CMS doesn’t publish an office rate for 15958 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 15958 covers
This operation treats a pressure ulcer over the greater trochanter by removing the ulcer and performing an ostectomy, then covering the defect with a muscle or myocutaneous flap. Plastic and reconstructive surgeons commonly perform it for deep, complex wounds, including in patients with prolonged immobility or spinal cord injury. It is a facility-based reconstructive procedure rather than simple wound closure or surface debridement.
Choose this code when the operative report supports all three elements: trochanteric ulcer excision, bone removal, and muscle or myocutaneous flap coverage. Document the ulcer site, the ostectomy, and the flap used. The 90-day global includes the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate. Assistant-at-surgery payment is barred; 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 15958 pays more and less in Washington
| Payment locality | Office | Facility |
|---|---|---|
| Rest Of Washington | Unavailable | $1,088.08 |
| Seattle (King Cnty) | Unavailable | $1,189.26 |
How the 15958 rate is calculated
Each of 15958’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 · 15958
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 16.33Practice expense 12.90Malpractice 3.22
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 15958
15958 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 15958
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 · 15958
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
15958 without 51 · national facility
$1,083.86
Pressure ulcer surgery
15958-51 · Second procedure: 50%
$541.93
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%).
15958 compared with similar codes
Compare codes
15958 vs 15956 vs 15953 vs 15951 vs 15937: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 15956Pressure ulcer excision
- Both describe trochanteric ulcer excision with muscle or myocutaneous flap coverage. Choose 15958 when an ostectomy is also performed.
- 15953Pressure ulcer surgery
- Both include trochanteric ulcer excision and ostectomy. The distinguishing coverage is a skin flap for 15953 versus a muscle or myocutaneous flap for 15958.
- 15951Pressure ulcer excision
- This is the trochanteric ostectomy option without the muscle or myocutaneous flap combination described by 15958.
- 15937Pressure ulcer surgery
- This code describes the analogous ostectomy and muscle-flap approach at a sacral pressure ulcer; 15958 is for the trochanteric site.
15958 billing questions
When is 15958 selected instead of 15956?
Use 15958 when the trochanteric ulcer excision includes both an ostectomy and muscle or myocutaneous flap coverage. Code 15956 describes the muscle or myocutaneous flap approach without the ostectomy element.
How does 15958 differ from 15953?
Both include trochanteric ulcer excision and ostectomy, but 15958 uses muscle or myocutaneous flap coverage; 15953 uses a skin flap.
What operative documentation supports 15958?
Document the ulcer's trochanteric location, excision, bone removal, and the muscle or myocutaneous flap used for coverage. The record should make clear that these elements were performed in the same operation.
Can modifier 50 be reported for bilateral trochanteric ulcers?
No. CMS identifies bilateral adjustment as inapplicable to this code, so modifier 50 is inappropriate.
How are additional same-session procedures and postoperative care handled?
The 90-day global includes the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in one session, the highest-valued procedure is paid in full and others are subject to the standard 50% reduction.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment is barred for this code. Co-surgeons are paid only when supporting documentation is provided; 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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