CPT 11044 and 11047: Billing Bone Debridement in Wound Care

CPT 11044 and 11047: Billing Bone-Level Excisional Debridement

CPT 11044 bone debridement billing is the highest-paying code in the excisional debridement series and the one most likely to draw an audit. When the deepest tissue plane you reach during debridement is bone, cortical periosteum, or tendon-to-bone junction, CPT 11044 is the correct base code — but only if you can prove it in documentation. The reimbursement is real (approximately $330 for the first 20 sq cm at Medicare rates), and so is the scrutiny.

This guide covers the clinical threshold for 11044, how to select it correctly within the 11042-11047 hierarchy, documentation that survives audit, and the add-on code 11047 for larger debridement fields. For the full debridement code family including 11042 and 11043, see the CPT 11042 Excisional Debridement Guide.

What CPT 11044 Covers

CPT 11044 describes excisional debridement of the first 20 sq cm or less of wound surface area when the deepest tissue plane reached during the procedure is bone, tendon, or joint capsule.

By definition, 11044 also includes debridement of all tissue planes above bone — epidermis, dermis, subcutaneous tissue, fascia, and muscle — because you passed through all of them to reach bone. You do not bill 11042 or 11043 separately on the same wound.

Medicare national average reimbursement:

CPT 11044: approximately $330 (first 20 sq cm)
CPT 11047: approximately $100 per additional 20 sq cm

These are professional fee rates for non-facility settings. Hospital outpatient rates differ under the OPPS APC structure.

The 11042-11047 Hierarchy: Deepest Plane Rules

The coding rule is unambiguous: you code to the deepest tissue plane reached, not the plane where most debridement occurred. The full hierarchy is:

Code	Deepest Plane	Add-On	Medicare Rate (approx.)
11042	Subcutaneous tissue	11045	~$125
11043	Muscle or fascia	11046	~$245
11044	Bone, tendon, or joint capsule	11047	~$330

If you debride primarily through subcutaneous and muscle tissue but expose cortical bone at any point, the code is 11044. If you only reach the level of the deep fascia without exposing bone or tendon, the code is 11043. The critical word is "reached" — even brief visualization of bone during the procedure justifies 11044 if it is documented.

Tissue structures that support 11044 include cortical bone, periosteum, tendon-to-bone junction, and joint capsule. Viable muscle alone — even deep muscle — is 11043, not 11044. Do not step up to 11044 unless bone-equivalent structure is confirmed reached and documented.

When CPT 11044 Arises in Practice

The two most common drivers of bone-level debridement are diabetic foot ulcers with osteomyelitis or exposed bone, and Stage 4 pressure injuries that extend to sacral cortex, calcaneus, or ischial prominence. Dehisced surgical wounds over hardware or post-amputation stump breakdown are a third pathway.

A positive probe-to-bone test or MRI confirming osteomyelitis does not by itself justify 11044. The procedure must reach bone and the note must document active debridement of bone-level tissue. For osteomyelitis identification and clinical workup, see the Osteomyelitis Screening Guide.

Documentation Requirements for CPT 11044

The Core Elements

Every 11044 claim requires documentation that explicitly establishes bone-level debridement occurred. Auditors reviewing a 11044 claim are looking for five things:

Pre-procedure wound assessment. Wound location (include laterality), dimensions (L x W in cm, surface area in sq cm), wound depth, wound bed composition, presence of exposed or palpable bone or tendon, undermining or tunneling measurements.
Clinical indication for bone-level debridement. Why was debridement to this depth necessary? Acceptable documentation: "Necrotic cortical bone visualized at wound base, requiring debridement to viable periosteum." Or: "Osteomyelitis confirmed by MRI; active debridement of infected bone cortex performed." A vague notation of "bone visible" without linking to a debridement action is not enough.
Instrument and technique. Name what you used: rongeur, bone curette, scalpel to periosteum, power burr. Describe the motion: "Infected cortical bone removed with bone rongeur until viable bleeding bone surface achieved." A note that says "wound debrided" without specifying the instrument or technique will not support 11044.
Explicit confirmation of bone-level tissue. Use precise anatomical language: "Cortical bone debrided," "periosteum incised and debrided," "exposed calcaneus debrided to viable tissue," "bone curette applied to sacral cortex." The word "bone" must appear in the procedure description in a way that confirms you acted on it — not just that you saw it.
Post-debridement wound bed. Describe what the wound looks like after debridement: "Wound base demonstrates viable cancellous bone with punctate bleeding. Surrounding soft tissue shows healthy granulation." This confirms the debridement reached its target depth and was clinically adequate.

The Osteomyelitis Documentation Problem

Osteomyelitis is frequently the underlying condition that leads to bone-level debridement. But the ICD-10 code for osteomyelitis and the CPT code for bone debridement are not automatically linked. You can have osteomyelitis confirmed by imaging and never perform a bone debridement on that visit (if the debridement was limited to soft tissue, you bill 11042 or 11043). You can also perform bone debridement on a wound without a formal osteomyelitis diagnosis (exposed necrotic bone in a pressure injury, for example).

Bill 11044 based on what you actually did during the procedure. Document accordingly. Do not inflate the code to 11044 simply because osteomyelitis is on the problem list.

Conversely: if you genuinely debrided bone and only documented "soft tissue wound care," you are undercoding. For a full discussion of accurate code selection across the debridement hierarchy, see the Wound Care Debridement Billing Guide and Wound Care CPT Codes 2026.

CPT 11047: Add-On Code for Larger Wound Fields

CPT 11047 is the add-on code for bone-level excisional debridement of each additional 20 sq cm of wound surface area, reported in addition to 11044.

Billing rule: Calculate total wound surface area (in sq cm) before debridement begins. Subtract the first 20 sq cm covered by 11044. Divide the remainder by 20 (round up to the next unit for any partial increment).

Example: 55 sq cm wound debrided to bone.

11044 x 1 (first 20 sq cm)
11047 x 2 (sq cm 21-40 = one unit; sq cm 41-55 = second unit)

Bill: 11044, 11047 x 2

Do not add 11047 unless bone-level debridement extends across the entire wound field. If your 55 sq cm wound has bone exposure only at a 15 sq cm central area while the surrounding 40 sq cm is debrided only to subcutaneous tissue, you have a complex multiple-wound billing scenario — not a simple 11044 + 11047 addition. The deepest-plane rule applies across the wound being billed.

Multiple Wounds and Same-Day Billing

Same depth, multiple wounds: Combine wound areas and bill 11044 + 11047 for the total. Two wounds both debrided to bone — 18 sq cm and 22 sq cm — combine to 40 sq cm: bill 11044 x 1 + 11047 x 1. Document each wound separately.

Mixed depths on the same visit: Bill 11044 for the bone-level wound and 11042 or 11043 for the shallower wound, with modifier -59 (or applicable X-modifier) on the lesser code to indicate distinct anatomical sites. Do not combine surface areas across different debridement depths.

Bone debridement plus skin substitute application on the same visit: CMS permits billing both when clinically justified. Modifier -59 on the skin substitute CPT code is typically required, along with documentation explaining that the debridement and grafting were distinct procedural steps. At the 2026 CMS flat rate of $127.14/sq cm, skin substitutes carry independent audit risk — see the Skin Substitute Billing Guide for graft-specific documentation rules.

LCD Compliance for Bone-Level Debridement

Bone debridement in the wound care setting is covered under Medicare when medically necessary, but the LCD requirements your MAC applies — specifically for excisional debridement and for wound care visits generally — still apply to 11044 claims. Non-compliance with LCD criteria for wound care coverage remains the most common reason for excisional debridement denials across the board.

Key LCD compliance elements for bone debridement:

Documentation of treatment failure at a lesser depth or with non-surgical methods (why bone debridement was necessary)
Evidence of ongoing wound assessment at prior visits showing wound progression
Appropriate ICD-10 diagnosis coding (osteomyelitis codes, wound etiology codes, site specificity)
Wound measurements at the billed visit that support the surface area units claimed

For a detailed breakdown of LCD requirements affecting excisional debridement, see Wound Care LCD Compliance.

Key Takeaways

CPT 11044 covers excisional debridement when the deepest tissue plane reached is bone, periosteum, or joint capsule, first 20 sq cm. Medicare reimburses approximately $330.
CPT 11047 is the add-on for each additional 20 sq cm of bone-level debridement, approximately $100 per unit.
You code to the deepest plane touched, even if only briefly. If bone is reached, 11044 is the correct base code regardless of how much of the debridement was at shallower levels.
Osteomyelitis on the diagnosis list does not automatically justify 11044. The procedure note must document active debridement of bone-level tissue with specific anatomical language.
Multiple wounds at the same depth: combine surface areas. Mixed depths: bill each depth separately with modifier -59.
LCD compliance for the underlying wound care visit is still required even when 11044 is the correct code.