L97.419 — Non-pressure chronic ulcer of right heel and midfoot with unspecified severity

Risk adjustment

L97.419 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:

• HCC 383 Chronic Ulcer of Skin, Except Pressure, Not Specified as Through to Bone or Muscle0.646 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

L97.419 is named in 5 Medicare coverage policies — 3 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
• A52993Billing and Coding: Peripheral Venous Ultrasound
• A56758Billing and Coding: Non-Invasive Vascular Studies