Exc sac pr ulc prep mus ostc
Surgical removal of sacral pressure sores with muscle and bone preparation ranges from $924 to $1,829 depending on facility type, making bill verification essential given the potential difference of $905 across care settings.
About the analyst
Kevin Nyk analyzes hospital pricing data at BillRazor Research. He specializes in Medicare reimbursement patterns and chargemaster pricing across U.S. hospitals. Expertise: hospital pricing, Medicare rates, chargemaster analysis.
This procedure removes infected tissue and bone from pressure sores that develop on the tailbone area, typically requiring muscle flap reconstruction. Patients are usually bedridden individuals with severe mobility limitations from spinal cord injuries, advanced age, or chronic illness. Code 15937 carries significant reimbursement variation, with facility charges often exceeding 12.0x the Medicare benchmark of approximately $2,100.
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Facility rate
$924
National Medicare benchmark
Non-facility rate
$99
Office setting benchmark
Data sources
4
24 data points
Key insights for CPT 15937
ASC vs hospital outpatient savings
$848Having this done at an ambulatory surgery center costs $981 vs $1,829 at a hospital outpatient
Facility vs office setting
$825 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) | $924 | +833% |
| Non-facility (office) | $99 | Lowest |
| Outpatient (APC) | $1,829 | +1748% |
| Ambulatory surgery (ASC) | $981 | +891% |
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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