What is ICD-10 code L97.401?

L97.401 is the ICD-10-CM diagnosis code for Non-pressure chronic ulcer of unspecified heel and midfoot limited to breakdown of skin. A long-lasting open sore on the heel or midfoot area that is not caused by pressure, with only the outer skin layer broken down. L97.401 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. L97.401 is part of the FY2026 ICD-10-CM code set published by the CMS National Center for Health Statistics and used on Medicare, Medicaid, and commercial claims in the United States.

Yes. L97.401 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. L97.401 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

Which HCC does L97.401 map to under V28?

L97.401 maps to CMS-HCC V28 383 (Chronic Ulcer of Skin, Except Pressure, Not Specified as Through to Bone or Muscle). The category number and label come from the CMS-HCC V28 model file for payment year 2026.

What does L97.401 pay in RAF?

L97.401 carries a community, non-dual, aged (CNA) RAF weight of 0.646 under CMS-HCC V28 for payment year 2026. The weight comes from the CMS V28 relative-factor file, not a hand-typed table.

What is the V28 vs V24 difference for L97.401?

CMS phased in the V28 risk adjustment model over payment years 2024 (33%), 2025 (67%), and 2026 (100%), replacing V24. V28 consolidates HCC categories, removes some lower-acuity conditions, and recalibrates RAF weights across the entire model. For L97.401, V28 maps to Chronic Ulcer of Skin, Except Pressure, Not Specified as Through to Bone or Muscle at RAF 0.646 while V24 mapped to Chronic Ulcer of Skin, Except Pressure at RAF 0.515. Both models can still appear in legacy data and in payer-specific lookback periods.

What documentation supports L97.401?

Confirm the ulcer location is heel or midfoot and that only skin breakdown is present without deeper tissue involvement This represents the least severe category of non-pressure ulcers at this location Because L97.401 maps to a payment HCC, the documentation must also satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's risk adjustment score. See the MEAT criteria checklist at /meat-criteria for what Monitor, Evaluate, Assess, or Treat looks like in a note. MEAT is generic documentation evidence, not a payer-specific rule.

2026 ICD-10-CM L97.401: Non-pressure chronic ulcer

L97.401 maps to CMS-HCC V28 383 (RAF 0.646). Documentation must support MEAT. MEAT criteria · RAF calculator · free HCC coding tools

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Code lookupL97.401Effective periodFY2026 Apr Update (Apr 1-Sep 30)

FY 2026 Apr update / Diseases of the skin and subcutaneous tissue (L00-L99) / Other disorders of the skin and subcutaneous tissue (L80-L99)

L97.401

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

Non-pressure chronic ulcer of unspecified heel and midfoot limited to breakdown of skin

A long-lasting open sore on the heel or midfoot area that is not caused by pressure, with only the outer skin layer broken down.

Buddy Insight

This represents the earliest stage of non-pressure chronic ulceration, limited to epidermal/dermal disruption.

CMS-HCC V28

Mapped

HCC 383

Chronic Ulcer of Skin, Except...

RAF 0.646

CMS-HCC V24

Mapped

HCC 161

Chronic Ulcer of Skin, Except...

RAF 0.515

ACA/HHS

Mapped

HCC 217

HHS-HCC 217

Varies by metal level

ESRD/PACE

Mapped

HCC 161

Chronic Ulcer of Skin, Except...

RAF 0.127

RXHCC

Mapped

HCC 311

Diabetic and Chronic Skin Ulcer

RAF 0.175

Code Book Path

Official

L97.4Non-pressure chronic ulcer of heel and midfoot

L97.40Non-pressure chronic ulcer of unspecified heel and midfoot

L97.401Non-pressure chronic ulcer of unspecified heel and midfoot limited to breakdown of skin

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for L97.401 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for L97.401 in this effective period.

Related Child Codes

Official

L97.402Non-pressure chronic ulcer of unspecified heel and midfoot with fat layer exposed

L97.403Non-pressure chronic ulcer of unspecified heel and midfoot with necrosis of muscle

L97.404Non-pressure chronic ulcer of unspecified heel and midfoot with necrosis of bone

L97.405Non-pressure chronic ulcer of unspecified heel and midfoot with muscle involvement without evidence of necrosis

L97.406Non-pressure chronic ulcer of unspecified heel and midfoot with bone involvement without evidence of necrosis

Includes

Official

ICD-10-CM does not list Includes notes for L97.401 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for L97.401 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for L97.401 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for L97.401 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for L97.401 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

Specific anatomic location documented as unspecified heel and midfoot

Confirmation that the ulcer is non-pressure in etiology (not caused by pressure/immobility)

Chronicity established — ulcer present for extended duration or described as chronic

Current wound assessment including size (length x width x depth in centimeters)

MEAT Support

HCC Buddy guidance

Specific anatomic location documented as unspecified heel and midfoot

Confirmation that the ulcer is non-pressure in etiology (not caused by pressure/immobility)

Chronicity established — ulcer present for extended duration or described as chronic

Current wound assessment including size (length x width x depth in centimeters)

Audit Caution

HCC Buddy guidance

Confusing non-pressure ulcers (L97) with pressure ulcers (L89) — verify the etiology is NOT pressure/immobility-related before assigning L97 codes

Using unspecified laterality when the medical record documents left or right — always code to the highest specificity supported by documentation

Using skin breakdown code when the wound has clearly progressed to deeper tissue layers — review wound assessment for depth

Confusing initial skin breakdown with a healing ulcer that has granulated back to superficial depth — document current status, not historical

Common Mistakes

HCC Buddy guidance

L97.402 — Fat layer exposed at same location; use when ulcer has progressed beyond skin to expose subcutaneous fat

L97.409 — Unspecified severity at same location; skin breakdown is more specific and preferred when documented

L89.0xx (Pressure ulcer of elbow) / L89.6xx (Pressure ulcer of heel) — Pressure ulcers use the L89 category; L97 is specifically for NON-pressure chronic ulcers

L97.411 — Same severity but specified as RIGHT side; use laterality-specific code when documentation supports it

Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →

Is L97.401 an HCC code?

Yes. L97.401 (Non-pressure chronic ulcer of unspecified heel and midfoot limited to breakdown of skin) maps to Chronic Ulcer of Skin, Except Pressure, Not Specified as Through to Bone or Muscle under the CMS-HCC V28 risk adjustment model (and Chronic Ulcer of Skin, Except Pressure under V24), with a community non-dual aged RAF of 0.646. It is billable for payment year 2026.

Coder answer: L97.401 is billable and maps to V28 HCC 383, Chronic Ulcer of Skin, Except Pressure, Not Specified as Through to Bone or Muscle. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.

Code: L97.401
Description: Non-pressure chronic ulcer of unspecified heel and midfoot limited to breakdown of skin
HCC (V28): HCC 383 — Chronic Ulcer of Skin, Except Pressure, Not Specified as Through to Bone or Muscle
RAF: 0.646
Billable: Yes
Payment year: 2026

HCC Category Mapping

V28HCC 383, Chronic Ulcer of Skin, Except Pressure, Not Specified as Through to Bone or Muscle

0.646

V24HCC 161, Chronic Ulcer of Skin, Except Pressure

0.515

ESRDHCC 161, Chronic Ulcer of Skin, Except Pressure

0.127

RxHCCHCC 311, Diabetic and Chronic Skin Ulcer

0.175

Each model's RAF is its CMS base weight for that model's standard population, so weights are not directly comparable across models: CMS-HCC V28 and V24 use Community, Non-Dual, Aged; ESRD uses the dialysis continuing-enrollee model; RxHCC is the Part D continuing-enrollee, non-low-income, aged weight (a larger scale than CMS-HCC). ACA/HHS has no single weight — it varies by metal level. Actual per-patient RAF contribution depends on member segment, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains in use during the transition and for historical data.

Work L97.401 in the Code Book — tabular path, V28 RAF, and MEAT checklist →

MEAT Criteria for L97.401

For L97.401 to count as a valid HCC diagnosis in a given encounter, the provider's documentation must show MEAT: Monitor, Evaluate, Assess, or Treat. A diagnosis from a prior year does not carry forward automatically, it has to be re-documented and supported each calendar year.

MMonitor: signs, symptoms, disease progression, or lab trending documented in the note
EEvaluate: test results, medication response, or physical findings reviewed by the provider
AAssess: explicit mention in the assessment or plan with acknowledgment of status
TTreat: medication, referral, procedure, therapy, or counseling tied to the diagnosis

Only one of M/E/A/T is required to support the code, but the documentation must be specific enough to show that the provider actually addressed L97.401 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

L97.401 is the ICD-10-CM diagnosis code for non-pressure chronic ulcer of unspecified heel and midfoot limited to breakdown of skin. A long-lasting open sore on the heel or midfoot area that is not caused by pressure, with only the outer skin layer broken down. L97.401 sits in the ICD-10-CM chapter for diseases of the skin and subcutaneous tissue (l00-l99), within the section covering other disorders of the skin and subcutaneous tissue (l80-l99).

Under the CMS-HCC V28 risk adjustment model, L97.401 maps to Chronic Ulcer of Skin, Except Pressure, Not Specified as Through to Bone or Muscle (HCC 383) with a community, non-dual, aged base RAF weight of 0.646. Under the older CMS-HCC V24 model, L97.401 maps to Chronic Ulcer of Skin, Except Pressure (HCC 161) with a community, non-dual, aged base RAF weight of 0.515. V28 is the CMS-HCC risk adjustment model that reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition.

Confirm the ulcer location is heel or midfoot and that only skin breakdown is present without deeper tissue involvement. Because L97.401 maps to a payment HCC, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's Medicare Advantage risk adjustment score. When documentation is ambiguous, coders should issue a provider query rather than assume the highest-specificity variant.

HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for L97.401 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Confirm the ulcer location is heel or midfoot and that only skin breakdown is present without deeper tissue involvement
•This represents the least severe category of non-pressure ulcers at this location

Clinical Significance

This represents the earliest stage of non-pressure chronic ulceration, limited to epidermal/dermal disruption. While the least severe classification, it still indicates a chronic wound requiring ongoing management and signals potential for progression to deeper tissue involvement. Accurate laterality documentation (unspecified heel and midfoot) is essential for proper code assignment and tracking wound progression over time.

Documentation Requirements

✓Specific anatomic location documented as unspecified heel and midfoot
✓Confirmation that the ulcer is non-pressure in etiology (not caused by pressure/immobility)
✓Chronicity established — ulcer present for extended duration or described as chronic
✓Current wound assessment including size (length x width x depth in centimeters)
✓Documentation that ulcer is limited to skin breakdown without deeper tissue involvement
✓Wound bed description confirming no exposed subcutaneous tissue, muscle, or bone
✓Underlying etiology or contributing factors (diabetes, peripheral vascular disease, venous insufficiency)
✓Current treatment plan including wound care regimen

Commonly Confused Codes

•L97.402: Fat layer exposed at same location; use when ulcer has progressed beyond skin to expose subcutaneous fat
•L97.409: Unspecified severity at same location; skin breakdown is more specific and preferred when documented
•L89.0xx (Pressure ulcer of elbow) / L89.6xx (Pressure ulcer of heel): Pressure ulcers use the L89 category; L97 is specifically for NON-pressure chronic ulcers
•L97.411: Same severity but specified as RIGHT side; use laterality-specific code when documentation supports it
•L97.421: Same severity but specified as LEFT side; use laterality-specific code when documentation supports it
•E11.621 (Type 2 diabetes mellitus with foot ulcer): If ulcer is due to diabetes, code the diabetic complication first and the L97 code as an additional code to specify site and severity