CPT 11042: Debridement, Subcutaneous Tissue, First 20 sq cm
CPT 11042 reports surgical debridement of subcutaneous tissue (including epidermis and dermis if performed) for the first 20 sq cm or less. It is a depth-and-area wound care code. In 2026 Medicare pays about $132.60 non-facility and $55.78 facility, with a 000-day global period.
- Code type
- Surgical - debridement of subcutaneous tissue, first 20 sq cm
- 2026 non-facility
- $132.60
- 2026 facility
- $55.78
- Global period
- 000 days
What is CPT 11042 used for?
CPT 11042 reports surgical debridement of subcutaneous tissue, including the epidermis and dermis if they are also debrided, for the first 20 sq cm or less. It is used for pressure ulcers, diabetic foot wounds, and other wounds where devitalized tissue down to the subcutaneous layer is excised with a sharp instrument.
The defining element is depth. 11042 is the subcutaneous-level code; muscle or fascia debridement moves up to 11043, and bone debridement to 11044. The deepest layer of viable tissue removed determines the base code.
How much does 11042 pay in 2026?
Under the 2026 Medicare fee schedule, 11042 allows about $132.60 non-facility and $55.78 facility.
| Setting | 2026 Medicare allowed |
|---|---|
| Non-facility (office) | ~$132.60 |
| Facility (hospital outpatient) | ~$55.78 |
Example: a wound clinic sharply debrides a 15 sq cm sacral ulcer to the subcutaneous level in the office. You bill one unit of 11042 at about $132.60. Check your locality figure with the Medicare fee calculator.
How do depth and area rules work?
Two rules control 11042: code to the deepest tissue removed, and measure the area after debridement. When multiple wounds are debrided at the same depth, sum their areas; do not combine areas from different depths.
- Identify the deepest tissue layer removed to pick the base code.
- Measure the debrided surface area once the procedure is finished.
- Sum same-depth wounds, then apply +11045 for each additional 20 sq cm.
What bundling edits apply to 11042?
The biggest unbundling risk is reporting 11042 with active wound care management 97597-97602 for the same wound and date; the NCCI edits prohibit it. Only one applies per wound based on the tissue level. When distinct wounds at different sites are treated, modifier 59 or an X-modifier may separate them if documentation supports it. Every debridement claim must meet medical necessity with a documented wound diagnosis and measurable devitalized tissue. Related integumentary work includes 10060.
Frequently asked questions
In 2026 the national non-facility allowed amount is about $132.60, and the facility rate is about $55.78. The office rate is higher because the practice supplies the instruments and staff. Medicare pays 80 percent and the patient or secondary plan owes the 20 percent coinsurance after the deductible.
11042 covers the first 20 sq cm. For each additional 20 sq cm or part thereof at the same depth, add +11045. The add-on does not need modifier 51 or 59 when reported correctly with 11042. Measure the area after debridement, not before.
No. Surgical debridement codes 11042-11047 and active wound care codes 97597-97602 cannot be billed for the same wound on the same date. 11042 is excisional surgical debridement; 97597 is superficial non-surgical wound care. Choose the one that matches the tissue level actually removed.
Sources & further reading
Reviewed by the ImmediCare Solutions RCM team
Certified billers and coders handling claims across 50+ specialties nationwide. This entry is reviewed against current payer policy and CMS rules. Last review: Jul 5, 2026.
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