L97.204 — Non-pressure chronic ulcer of unspecified calf with necrosis of bone

Risk adjustment

L97.204 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:

• HCC 380 Chronic Ulcer of Skin, Except Pressure, Through to Bone or Muscle1.078 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

L97.204 is named in 3 Medicare coverage policies — 1 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
• A53065Billing and Coding: Outpatient Physical Therapy