L97.906
BillableNon-pressure chronic ulcer of unspecified part of unspecified lower leg with bone involvement without evidence of necrosis
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is L97.906 an HCC code?
Yes. L97.906 maps to Chronic Ulcer of Skin, Except Pressure 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 L97.906
For L97.906to 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 L97.906 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
L97.906 is the ICD-10-CM diagnosis code for non-pressure chronic ulcer of unspecified part of unspecified lower leg with bone involvement without evidence of necrosis. A long-lasting open sore on the lower leg that is not caused by pressure, with bone damage visible but no dead tissue present. L97.906 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, L97.906 maps to Chronic Ulcer of Skin, Except Pressure (HCC 380) with a community, non-dual, aged base RAF weight of 0.426. The V24 model used during the PY2024–PY2025 transition mapped L97.906 the same way and at the same RAF weight. 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.
Verify documentation specifies bone involvement without necrosis to distinguish from other severity levels. Because L97.906 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 L97.906 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Verify documentation specifies bone involvement without necrosis to distinguish from other severity levels
- •Confirm the ulcer is non-pressure related and document the underlying cause when possible
Clinical Significance
This non-pressure chronic ulcer on the unspecified part of unspecified lower leg with viable bone involvement indicates the ulcer has reached bone without causing osteonecrosis, representing a critical window where intervention may prevent bone death. 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 bone involvement/exposure
- ✓Explicit documentation that bone is viable (no necrosis present)
- ✓Imaging studies confirming bone involvement without osteonecrosis
- ✓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
- •L97.904 — bone necrosis — this code requires necrosis (tissue death) to be present
- •L97.905 — muscle involvement without necrosis — less deep, does not involve bone
- •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