L98.A116 — Non-pressure chronic ulcer of right upper arm with bone involvement without evidence of necrosis

Risk adjustment

L98.A116 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

L98.A116 is named in 6 Medicare coverage policies — 6 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.

• A53057Billing and Coding: Home Health Occupational Therapy
• A53058Billing and Coding: Home Health Physical Therapy
• A53064Billing and Coding: Outpatient Occupational Therapy
• A53065Billing and Coding: Outpatient Physical Therapy