Exc sac pr ulc skn flp ostc
Surgical removal of sacral pressure sores with skin flap reconstruction costs range from $1,050 to $3,661 depending on facility type, making bill verification essential given this potential difference of $2,611.
About the analyst
Michael Glenn reviews CMS datasets and drug pricing at BillRazor Research. He focuses on NADAC acquisition costs and procedure coding accuracy. Expertise: drug pricing, NADAC data, CPT coding.
Code 15935 covers surgical removal of a pressure sore on the tailbone area, where surgeons cut away damaged tissue and use a skin flap to cover the wound, sometimes removing infected bone. This procedure typically applies to bedridden patients or wheelchair users who develop severe sores from prolonged pressure. Medicare reimbursement for this code averages $2,847, with facility charges often reaching 12.5x this benchmark amount.
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Facility rate
$1,050
National Medicare benchmark
Non-facility rate
$99
Office setting benchmark
Data sources
4
24 data points
Key insights for CPT 15935
ASC vs hospital outpatient savings
$1,704Having this done at an ambulatory surgery center costs $1,957 vs $3,661 at a hospital outpatient
Facility vs office setting
$951 differenceNon-facility setting is less expensive for this procedure
What this procedure costs across different settings
The same procedure can cost very different amounts depending on where it's performed. These are the Medicare-allowed amounts — what hospitals actually charge can be 3-10x higher.
| Setting | Medicare rate | vs lowest |
|---|---|---|
| Facility (physician office) | $1,050 | +961% |
| Non-facility (office) | $99 | Lowest |
| Outpatient (APC) | $3,661 | +3598% |
| Ambulatory surgery (ASC) | $1,957 | +1877% |
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About this data
Rates shown are from the 2026 Medicare Physician Fee Schedule, Hospital Outpatient Prospective Payment System (OPPS), Ambulatory Surgery Center Payment System, Clinical Laboratory Fee Schedule, Durable Medical Equipment Fee Schedule, and CMS Inpatient Prospective Payment System (DRG weights). Regional adjustments use CMS Geographic Practice Cost Indices (GPCI). Hospital charges are from CMS Hospital Price Transparency machine-readable files. All data is publicly available under federal law (45 CFR Part 180).
This data is for informational purposes only and does not constitute medical or financial advice. Actual costs depend on insurance coverage, negotiated rates, and individual circumstances.
Data: Medicare Physician Fee Schedule, CMS Inpatient PPS (IPPS), Outpatient PPS (OPPS), ASC Payment System, Clinical Lab Fee Schedule (CLFS), National Average Drug Acquisition Cost (NADAC). FY 2024 data. All publicly available from CMS.
Methodology: Facility rate applies when the procedure is performed in a hospital or ASC. Non-facility rate applies in a physician office. GPCI adjustments reflect regional cost-of-living differences.
This information is for educational purposes only and is not medical, financial, or legal advice. Actual costs depend on your insurance and provider. We recommend verifying costs directly with your provider. Full methodology · Terms of use