Wound Care CPT Code Cheat Sheet 2026

Every wound care CPT code, current Medicare non-facility rates, documentation requirements, frequency limits, and modifiers in one reference. Rates are 2026 non-facility; facility rates are lower.

Selective Debridement

Code	Description	Non-Facility Rate	Monthly Limit
97597	First 20 sq cm	~$82	4/month
+97598	Each add. 20 sq cm	~$38	Per session

Required documentation: Devitalized tissue with clinical rationale. Selective technique — instrument named. Epidermis/dermis only (no deeper). L×W×D measurements. Tissue percentages. Pre/post wound status. Vascular status for lower extremity. Medical necessity stated.

KX modifier: Required at 5th+ debridement in same calendar month.

Surgical Debridement

Code	Depth	First 20 sq cm	Add-on	Add-on Rate	Annual Limit
11042	Subcutaneous fat	~$125	+11045	~$52	12/year
11043	Muscle or fascia	~$195	+11046	~$84	12/year
11044	Bone	~$243	+11047	~$110	12/year

Required documentation: Surgical technique. Instruments used. Specific depth language — "debrided to level of subcutaneous fat," "excised to viable muscle tissue." Measurements. Pre/post status. Medical necessity.

KX modifier: Required at 13th+ surgical debridement in same calendar year.

NPWT (Negative Pressure Wound Therapy)

Code	System	Area	Rate
97605	Non-disposable	First 50 sq cm	~$97
+97606	Non-disposable	Each add. 50 sq cm	~$49
97607	Disposable	First 50 sq cm	~$83
+97608	Disposable	Each add. 50 sq cm	~$40

Code by device type — not by wound type. Non-disposable reusable pump = 97605/97606. Disposable single-use unit = 97607/97608.

Skin Substitute Application (by wound site and size)

Code	Site	Area
15271	Trunk/arm/leg	First 25 sq cm
+15272	Trunk/arm/leg	Each add. 25 sq cm
15273	Trunk/arm/leg (pediatric)	First 10 sq cm
15274	Trunk/arm/leg (pediatric)	Each add. 10 sq cm
15275	Face/scalp/hands/feet	First 25 sq cm
+15276	Face/scalp/hands/feet	Each add. 25 sq cm
15277	Face/scalp/hands/feet (pediatric)	First 10 sq cm
15278	Face/scalp/hands/feet (pediatric)	Each add. 10 sq cm

Add Q code for specific product (Q4100–Q4299). WiSeR PA required before application in applicable states.

Modifier Reference

Modifier	Purpose
25	Significant, separately identifiable E/M same day as procedure
KX	Frequency limit exceeded; medical necessity documented in record
XS	Separate structure — multiple anatomically distinct wounds same session
LT	Left side
RT	Right side
TA	Left great toe
T1	Left 2nd toe
T2	Left 3rd toe
T3	Left 4th toe
T4	Left 5th toe
T5	Right great toe
T6	Right 2nd toe
T7	Right 3rd toe
T8	Right 4th toe
T9	Right 5th toe
FA	Left thumb
F1–F4	Left 2nd–5th finger
F5	Right thumb
F6–F9	Right 2nd–5th finger

Common Denial Codes

Denial	Cause	Fix
CO-50	Documentation doesn't support medical necessity	Quote LCD criteria verbatim in note
CO-119	Frequency exceeded without KX	Add KX with dated clinical rationale
CO-97	Missing modifier 25 on same-day E/M	Append 25 to E/M code
CO-11	ICD-10 not on covered diagnosis list	Review MAC billing article covered diagnoses
CO-4	Procedure inconsistent with modifier	Review wound site modifier application