L89.611 — Pressure ulcer of right heel, stage 1

Risk adjustment

L89.611 does not map to an HCC and does not risk-adjust under CMS-HCC V28. That is normal — most ICD-10 codes do not. It still needs to be coded correctly; it just will not move a RAF score.

Medicare coverage

L89.611 is named in 8 Medicare coverage policies — 6 listing it as supporting medical necessity, and 2 listing it as NOT covered. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.

• A56566Billing and Coding: Outpatient Physical and Occupational Therapy Servicesnot covered
• A57067Billing and Coding: Outpatient Physical and Occupational Therapy Servicesnot covered
• A53057Billing and Coding: Home Health Occupational Therapy
• A53058Billing and Coding: Home Health Physical Therapy