L97.416 — Non-pressure chronic ulcer of right heel and midfoot with bone involvement without evidence of necrosis

Risk adjustment

L97.416 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

L97.416 is named in 13 Medicare coverage policies — 12 listing it as supporting medical necessity, and 1 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
• A52993Billing and Coding: Peripheral Venous Ultrasound
• A53057Billing and Coding: Home Health Occupational Therapy
• A53058Billing and Coding: Home Health Physical Therapy