L97.901
BillableNon-pressure chronic ulcer of unspecified part of unspecified lower leg limited to breakdown of skin
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is L97.901 an HCC code?
Yes. L97.901 maps to Diabetic Skin Ulcer and Severe Skin Conditions under the CMS-HCC V28 risk adjustment model (and Chronic Ulcer of Skin, Except Pressure under V24).
HCC Category Mapping
RAF weights shown are the community, non-dual, aged base weights from the CMS risk adjustment model file. 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.
MEAT Criteria for L97.901
For L97.901to 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 L97.901 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
L97.901 is the ICD-10-CM diagnosis code for non-pressure chronic ulcer of unspecified part of unspecified lower leg limited to breakdown of skin. A long-lasting open sore on an unspecified part of an unspecified lower leg (not from pressure) that only affects the outer skin layer. L97.901 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, L97.901 maps to Diabetic Skin Ulcer and Severe Skin Conditions (HCC 383) with a community, non-dual, aged base RAF weight of 0.517. Under the older CMS-HCC V24 model, L97.901 maps to Chronic Ulcer of Skin, Except Pressure (HCC 161) with a community, non-dual, aged base RAF weight of 0.426. 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.
This code requires documentation that the ulcer is limited to skin breakdown only with no deeper tissue involvement. Because L97.901 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 L97.901 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This code requires documentation that the ulcer is limited to skin breakdown only with no deeper tissue involvement
- •Specify the leg (left or right) and location when possible to use a more specific code from the L97 category
Clinical Significance
This non-pressure chronic ulcer on the unspecified part of unspecified lower leg limited to skin breakdown represents the earliest stage of chronic ulceration, but still indicates impaired wound healing requiring clinical intervention. Chronic non-pressure ulcers are significant for risk adjustment because they indicate ongoing complex wound management needs, increased healthcare utilization, and often reflect underlying systemic conditions such as peripheral vascular disease, diabetes mellitus, or venous insufficiency. Accurate severity coding directly impacts care planning, specialist referral decisions, and appropriate resource allocation for wound care services.
Documentation Requirements
- ✓Confirmation that the ulcer is chronic (present for extended duration, not acute)
- ✓Documentation that the ulcer is NOT caused by pressure (non-pressure etiology)
- ✓Specific anatomical site of the ulcer on the unspecified part of unspecified lower leg
- ✓Query provider for laterality if not documented (left vs. right)
- ✓Wound assessment confirming ulcer is limited to skin breakdown only (epidermis/dermis)
- ✓No exposure of subcutaneous fat, muscle, or bone
- ✓Underlying etiology or contributing conditions (e.g., venous insufficiency, arterial disease, diabetes mellitus, neuropathy)
- ✓Current wound measurements (length, width, depth) and wound bed description
- ✓Current treatment plan and wound care management
Commonly Confused Codes
- •L97.902 — fat layer exposed — deeper involvement than skin-only breakdown
- •L97.909 — unspecified severity — use skin breakdown code when depth is documented
- •L89.xxx — Pressure ulcer codes; L97 is specifically for NON-pressure chronic ulcers
- •L97.5xx — Foot ulcer codes; verify whether the ulcer is on the leg or foot