Wound Care CPT Codes: Debridement, Skin Substitutes, NPWT

There is no single CPT code for wound care. The code depends on what was done at the visit: selective debridement (97597 and 97598), non-selective debridement (97602), debridement coded by the depth of tissue removed (11042 to 11047), negative pressure wound therapy (97605 to 97608), or application of a skin substitute (15271 to 15278, plus a code for the product). An E/M visit can be billed on the same day only when the note shows a separate assessment beyond the procedure. For debridement, the two facts that decide the code are the deepest layer of tissue actually removed and the surface area treated.

The rules below are Medicare's, from the fee schedule files, the CY 2026 Physician Fee Schedule final rule and the National Correct Coding Initiative (NCCI) policy manual. Medicare Administrative Contractors (MACs) also publish local coverage policies for wound care and skin substitutes, and commercial payers set their own, so check the policy that applies to the date of service. Payment varies by payer and locality; for Medicare, use the Physician Fee Schedule look-up.

Which codes cover wound care?

Described in our own words, with their status in the 2026 Medicare fee schedule:

The add-on codes (97598, 11045 to 11047, and the skin substitute add-ons) are reported only with their own primary code: 11045 goes with 11042, 11046 with 11043, and 11047 with 11044.

How do you choose a debridement code?

Start with the procedure note, and answer three questions.

1. What kind of debridement was it?

• Selective debridement removes devitalized tissue from the wound surface: 97597 and 97598.
• Non-selective debridement removes it without selecting tissue, for example with enzymatic agents or wet-to-moist dressings: 97602. Medicare doesn't pay it separately.
• Debridement by depth removes tissue down to and including a defined layer: 11042 to 11047.

A dressing change on its own is not debridement and isn't reported as one.

2. What is the deepest layer actually removed?

For the 11042 to 11047 codes, the code follows the deepest tissue removed, not how deep the wound is. A note that says the wound extends "to bone" doesn't support 11044 unless bone was debrided. The ulcer's stage or the depth in its diagnosis code doesn't decide the procedure code either.

3. What surface area was treated?

Area is measured in square centimeters. Guidance published by a Medicare contractor explains how to handle several wounds: add together the areas of wounds debrided to the same depth, but don't combine areas across different depths. A hypothetical example:

• Two wounds debrided to subcutaneous tissue, of 12 and 15 sq cm, total 27 sq cm: 11042 for the first 20 sq cm and 11045 for the rest.
• A third wound debrided to muscle, of 6 sq cm: 11043, reported separately, with a modifier such as 59 or XS if an NCCI edit would otherwise bundle it.

Which wound care services can't be billed together?

NCCI sets several limits:

• Selective or non-selective debridement and debridement by depth, for the same wound: 97597 to 97602 aren't reported with 11042 to 11047. 97602 isn't reported with 97597 or 97598 for the same wound.
• Debridement before a skin substitute: debridement of the wound before a graft or skin substitute is included in the application codes (15050 to 15278).
• Debridement at a tissue transfer site is included in the tissue transfer.
• Low-frequency ultrasound wound therapy (97610) isn't reported with other active wound care codes (97597 to 97606) or debridement codes for the same wound.
• Debridement that is part of another procedure, such as cleaning tissue around a lesion being removed or a wound being repaired, isn't reported separately.

Wound repair codes (12001 to 13160) describe closing a wound, not wound care. Don't use them for debridement or dressing care.

How are skin substitutes billed in 2026?

Two codes are needed: one for applying the product (15271 to 15278), and one HCPCS Level II code for the product itself, measured by the area used. NCCI says the primary application code describes one size and is reported with one unit; larger areas go on the add-on codes.

The CY 2026 Physician Fee Schedule final rule changed how Medicare pays for the products:

• Paid as supplies. In the office setting, skin substitute products are paid as incident-to supplies under the fee schedule, not as biologicals. Products approved as biologics under section 351 of the Public Health Service Act are the exception and are still paid as drugs.
• Grouped by FDA category. Products are grouped by how the FDA regulates them (PMA, 510(k), or section 361 human cell and tissue products). For 2026, CMS set one initial payment rate per square centimeter for all three groups, and applied the same approach in hospital outpatient departments.
• Product codes became add-on codes. In the 2026 fee schedule file, the product codes (Q4100-series and some A-codes) carry an add-on (ZZZ) global indicator, reported with the application code.

Coverage is separate from payment. Check the MAC's current local coverage policy for skin substitutes. In the six states of CMS's WISeR model (New Jersey, Ohio, Oklahoma, Texas, Arizona and Washington), applying skin substitutes to diabetic foot ulcers and venous leg ulcers of the lower extremity is subject to prior authorization (or pre-payment review) in Original Medicare. CMS's July 2026 operational guide says this doesn't currently apply in MAC jurisdiction JF, where the relevant policy was withdrawn.

When can a visit be billed with debridement?

Only when the record shows a significant, separately identifiable E/M service beyond the assessment that comes with the procedure, billed with modifier 25. Assessing the wound, performing the debridement and giving aftercare instructions on the same day are part of the procedure.

Contractor guidance also limits who may bill: debridement by depth (11042 to 11047) is billed by physicians and qualified non-physician practitioners; physicians, non-physician practitioners and therapists acting within their licence may provide selective and non-selective debridement.

What should the note include?

• The location of each wound, including side of the body.
• Measurements (length, width and depth) before treatment, and the area treated.
• The tissue present and the tissue removed, and the deepest layer removed.
• The method and instruments used.
• Each wound documented separately when there is more than one.
• Why the service was needed, and the plan of care.
• For skin substitutes: the product, the amount applied, any amount discarded, and the standard wound care tried first.

Diagnosis codes should match: for example, L97.412 is a non-pressure chronic ulcer of the right heel and midfoot with fat layer exposed, and L89.153 is a stage 3 pressure ulcer of the sacral region. E11.621 is type 2 diabetes mellitus with foot ulcer; check the ICD-10-CM tabular list for the additional code it calls for to identify the ulcer's site and severity.

Where do wound care claims go wrong?

• Depth: debridement billed by the depth of the wound instead of the tissue removed.
• Area: no measurements, areas at different depths added together, or add-on codes billed without the primary code.
• Bundling: debridement billed with a skin substitute application or with another debridement type on the same wound.
• Modifier 25 on a visit when the note only describes the procedure.
• Skin substitutes: no coverage check, missing product details, or the product billed without the application code.
• Multiple wounds described together, so the payer can't tell what was done to each.

For billing support, see Highview's wound care billing services. The guide to surgery CPT codes explains the 000 global period that applies to the debridement codes.

Sources

• CMS, PFS Relative Value Files, RVU26D: 2026 status and global periods of 97597–97610, 11042–11047, 15271–15278, 12001–13160 and the skin substitute product codes (status B for 97602; ZZZ for the add-on and product codes).
• CMS, Medicare NCCI Policy Manual, Chapter 3 (integumentary system, effective January 1, 2026), sections E, H and I: debridement included with lesion removal, repair, tissue transfer and skin substitute application; skin substitute primary and add-on codes.
• CMS, Medicare NCCI Policy Manual, Chapter 11 (effective January 1, 2026), section P: debridement code pairs that can't be reported for the same wound; 97610.
• Federal Register, CY 2026 Physician Fee Schedule final rule, section II.K, 90 FR 49486–49507: payment for skin substitutes as incident-to supplies, FDA categories, initial rate, conversion to add-on codes.
• First Coast Service Options (a Medicare contractor), Coding Guidelines: Wound Debridement Services, hosted by CMS: deepest level of tissue removed, adding areas at the same depth, dressing changes, who may bill, E/M with modifier 25. This is an older contractor document; check your own MAC's current guidance.
• CMS, WISeR Model Provider and Supplier Operational Guide (version 7.0, July 24, 2026), section 6.2.13, and the WISeR Model page.
• CDC/NCHS, FY 2027 ICD-10-CM code descriptions: L97.412, L89.153 and E11.621.
• CMS, Search the Physician Fee Schedule.