L89.94 — Pressure ulcer of unspecified site, stage 4

Risk adjustment

L89.94 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:

• HCC 379 Pressure Ulcer of Skin with Necrosis Through to Muscle, Tendon, or Bone1.965 RAF

Coefficient shown for the Community Non-dual Aged segment. A higher HCC in the same hierarchy will suppress this one, so capturing it does not always add score.

Medicare coverage

L89.94 is named in 4 Medicare coverage policies — 2 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
• A52468Pressure Reducing Support Surfaces - Group 3- Policy Article
• A53065Billing and Coding: Outpatient Physical Therapy