Wound Care CPT Cheat Sheet 2026: Quick Reference for Mobile Clinicians

This is the printable quick-reference version of our complete wound care CPT code guide. Every code is organized by visit type with Medicare POS 12 (home) reimbursement ranges, documentation triggers, and the modifiers that prevent denials. Bookmark it, print it, keep it in your bag.

Table 1: E/M Codes (Office/Outpatient Visits)

Bill with modifier -25 when performed on the same day as a procedure. MDM level determines the code — not time, unless time-based billing is elected.

Code	Description	MDM Level	Key MDM Criteria	Medicare POS 12
99213	Established patient, low MDM	Low	2+ self-limited problems; minimal data review; low risk of complications	~$75-$92
99214	Established patient, moderate MDM	Moderate	1+ chronic illness with exacerbation, or 2+ stable chronic conditions; moderate data review; Rx drug management	~$110-$130
99215	Established patient, high MDM	High	1+ chronic illness with severe exacerbation, or acute illness posing threat to life/function; extensive data review; high-risk decisions	~$155-$175

Most wound care visits land at 99214. A straightforward wound check with no change in plan is 99213. A wound with new infection, treatment plan overhaul, or multiple comorbidities affecting healing supports 99215.

Table 2: Debridement Codes

Two distinct families: selective (nonviable tissue only) and excisional (cutting into viable tissue with active bleeding). The clinical distinction drives the code — see the debridement billing guide for full documentation rules.

Selective Debridement

Code	Description	Size	Medicare POS 12
97597	Selective debridement, first wound	First 20 sq cm or less	~$80-$90
97598	Selective debridement, add-on	Each additional 20 sq cm	~$30-$40

Excisional Debridement (by deepest tissue layer)

Code	Description	Depth	Size	Medicare POS 12
11042	Excisional debridement	Skin/subcutaneous	First 20 sq cm	~$130-$150
11043	Excisional debridement	Muscle/fascia	First 20 sq cm	~$235-$255
11044	Excisional debridement	Bone	First 20 sq cm	~$340-$360
11045	Add-on to 11042	Skin/subcutaneous	Each addl 20 sq cm	~$45-$55
11046	Add-on to 11043	Muscle/fascia	Each addl 20 sq cm	~$70-$80
11047	Add-on to 11044	Bone	Each addl 20 sq cm	~$90-$105

Code to the deepest tissue layer removed. Add-ons must match their primary (11045 pairs only with 11042, etc.).

Table 3: Skin Substitute Application

Codes split by anatomical site: trunk/arms/legs vs. face/scalp/eyelids/hands/feet/genitalia. First code is the primary; second is the add-on for additional area.

Code	Description	Site	Size	Medicare POS 12
15271	Skin substitute graft, first	Trunk, arms, legs	First 25 sq cm	~$117 application + $127.14/sq cm product-$400
15272	Add-on to 15271	Trunk, arms, legs	Each addl 25 sq cm	~$60-$80
15275	Skin substitute graft, first	Face, scalp, hands, feet, genitalia	First 25 sq cm	~$117 application + $127.14/sq cm product-$420
15276	Add-on to 15275	Face, scalp, hands, feet, genitalia	Each addl 25 sq cm	~$65-$85

Measure graft size applied, not wound size. Document product name, lot number, and wound bed preparation. See our skin substitute billing guide for LCD requirements.

Table 4: Negative Pressure Wound Therapy (NPWT)

Code	Description	Indication	Medicare POS 12
97607	NPWT, wound surface area up to 50 sq cm	Wound area 50 sq cm or less per session	~$80-$100
97608	NPWT, wound surface area > 50 sq cm	Wound area exceeding 50 sq cm per session	~$115-$135

These are per-session codes. Document wound size at each visit. NPWT must be medically necessary with documented wound bed preparation and progress notes supporting continued use.

Table 5: Compression Therapy

Code	Description	Procedure	Medicare POS 12
29580	Strapping, Unna boot	Application of Unna boot zinc paste bandage	~$55-$70
29581	Multi-layer compression	Application of multi-layer venous wound compression system (e.g., Profore, Coban 2)	~$65-$80

Compression is separately billable from debridement and E/M. Document the type of system applied, number of layers, and the clinical indication (typically venous insufficiency with ICD-10 I87.2 or active venous ulcer L97.x).

Table 6: Common Modifiers

Modifier	Name	When to Use	Example
-25	Significant, separately identifiable E/M	E/M performed on same day as a procedure; the E/M must reflect decision-making beyond what's inherent to the procedure	99214-25 + 97597 on same visit
-59	Distinct procedural service	Two procedures that normally bundle, performed on separate wounds or anatomical sites	97597 on left leg wound + 97597-59 on right leg wound
-76	Repeat procedure, same physician	Same procedure repeated on a different wound during the same session	Second debridement on a separate wound same visit
-79	Unrelated procedure during postoperative period	Procedure unrelated to the original surgery during its global period	New wound debridement during post-op period of a prior skin graft
KX	Requirements met	Certifies that LCD/NCD coverage criteria have been met; required by some MACs for skin substitutes and NPWT	KX appended when LCD medical necessity documentation is complete

Full modifier rules with documentation examples in the modifier guide.

Table 7: Common Wound Care ICD-10 Codes

Code	Description	Typical Use
L97.119	Non-pressure ulcer of right thigh, unspecified severity	Venous/arterial leg ulcers by location
L97.519	Non-pressure ulcer of other part of right foot, unspecified severity	Foot ulcers (non-diabetic)
L97.929	Non-pressure ulcer of unspecified part of left lower leg, unspecified severity	Lower extremity ulcers, general
L89.150	Pressure ulcer of sacral region, unstageable	Sacral pressure injuries
L89.310	Pressure ulcer of right buttock, stage 1	Pressure injuries by stage (1-4)
E11.621	Type 2 diabetes with foot ulcer	Diabetic foot ulcer (pair with L97.x for site)
E11.622	Type 2 diabetes with other skin ulcer	Diabetic skin ulcer, non-foot
I87.2	Venous insufficiency (chronic/peripheral)	Underlying cause for venous leg ulcers
L03.115	Cellulitis of right lower limb	Wound infection/cellulitis
T81.31XA	Disruption of external operation wound, initial encounter	Surgical wound dehiscence

Code to the highest specificity available. Laterality (left/right), anatomical site, severity, and stage all affect code selection. Use E11.621 + L97.x together for diabetic foot ulcers — the diabetes code alone is insufficient. Pressure ulcers require staging (L89.x10 through L89.x14 for stages 1-4).

Reimbursement ranges shown are 2026 Medicare Physician Fee Schedule national averages for POS 12 (home). Actual rates vary by MAC jurisdiction, geographic locality, and payer contract. Verify current rates with your MAC or payer fee schedule.