Dbrdmt opn wnd addl 20cm/<
CPT 97598 is an add-on code used when a healthcare provider removes dead or infected tissue from an open wound that covers an additional 20 square centimeters or less beyond the first area already treated.
RVU breakdown
Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High
Billing tips
Always bill 97598 with primary debridement code 97597; never bill 97598 alone as it is a list separately in addition to (add-on) code
Impact: Billing 97598 without 97597 results in automatic denial and $0 reimbursement; proper pairing ensures full $43.34 payment per unit
Document exact wound surface area measurements in square centimeters for each debridement area; use length × width calculation
Impact: Precise measurements justify number of units billed; each additional 20 cm² or less equals one unit of 97598 at $43.34
Bill multiple units of 97598 when total additional wound area exceeds 20 cm² (e.g., 35 cm² additional area = 2 units of 97598)
Impact: Underbilling loses legitimate revenue; 2 units = $86.68 vs 1 unit = $43.34, a $43.34 revenue difference
Understand facility vs non-facility setting difference: outpatient hospital departments yield $23.29 while office/clinic settings yield $43.34
Impact: Place of service code affects reimbursement by $20.05 per unit (46% difference); verify correct POS code 11 vs 22
Check therapy cap exemptions if billing under PT/OT benefit; medically necessary wound debridement typically qualifies for exception
Impact: Prevents patient financial liability when therapy caps are reached; maintains access to necessary care and full reimbursement
Review NCCI edits monthly; 97598 bundles with many E/M codes unless modifier 25 (for separately identifiable E/M) is appropriately used
Impact: Unbundling violations trigger recoupment; proper modifier use can add $50-150 for legitimate separate E/M service
Common denials
Billed without primary code 97597 or incorrect primary code used
How to appeal: Submit corrected claim with both 97597 (primary) and 97598 (add-on) codes; include operative note showing total wound area debridement; reference CPT guidelines stating 97598 is add-on only to 97597
Insufficient documentation of wound size measurements or total surface area not supporting number of units billed
How to appeal: Provide detailed wound assessment documentation with length × width = area calculations in cm²; include wound diagrams or photographs if available; demonstrate calculation showing primary area (97597) plus additional areas (97598 units)
Medical necessity denial stating debridement not reasonable and necessary for wound healing
How to appeal: Submit clinical notes documenting wound condition (necrotic tissue, slough, infection signs); include wound healing plan and evidence of impaired healing without debridement; provide relevant diagnosis codes supporting medical necessity (diabetes with complications, pressure ulcer stages, etc.)
Frequency denial for debridement performed too often without demonstrated clinical progress
How to appeal: Provide serial wound assessments showing wound status changes; document reasons for continued debridement (ongoing necrosis, biofilm, infection); include photographs showing wound evolution; cite clinical guidelines for debridement frequency in chronic wounds
Frequently asked questions
What is CPT code 97598 used for?
CPT 97598 is an add-on code used to bill for selective debridement of open wounds covering an additional 20 square centimeters or less beyond the initial area. It must always be billed with the primary debridement code 97597 and represents extended wound care work on larger or multiple wound areas.
How much does Medicare pay for CPT 97598 in 2025?
Medicare pays $43.34 for CPT 97598 in non-facility settings (clinics, offices) and $23.29 in facility settings (hospital outpatient departments) based on the 2025 national average rates. Actual payment may vary by geographic locality using the Medicare Geographic Practice Cost Index (GPCI).
Can you bill 97598 without 97597?
No, CPT 97598 cannot be billed alone. It is an add-on code that must be reported with the primary debridement code 97597. Billing 97598 without 97597 will result in automatic claim denial as the code is defined as 'list separately in addition to code for primary procedure.'
How many units of 97598 can I bill?
You can bill multiple units of 97598 based on the total additional wound surface area beyond the first 20 cm² covered by 97597. Each additional 20 cm² or portion thereof equals one unit of 97598. For example, if you debride 75 cm² total, you would bill 97597 (first 20 cm²) plus 3 units of 97598 (remaining 55 cm² = 20+20+15).
What is the difference between 97597 and 97598?
CPT 97597 is the primary code for selective debridement of the first 20 square centimeters of wound surface area, while 97598 is the add-on code for each additional 20 cm² or less. 97597 is billed once per session regardless of wound size up to 20 cm², and 97598 is added for larger areas requiring more extensive debridement work.
Can physical therapists bill CPT 97598?
Yes, physical therapists can bill CPT 97598 when performing selective wound debridement within their scope of practice and state licensure. The service must be billed under the therapy benefit using modifier GP, must be medically necessary, and requires physician referral. Occupational therapists use modifier GO for the same service.
What documentation is required for billing CPT 97598?
Documentation must include precise wound measurements in square centimeters (length × width), total surface area calculations, description of tissue removed, debridement method and instruments used, wound location, medical necessity justification, and evidence that the additional area exceeds the primary 20 cm² covered by 97597. Wound diagrams or photographs strengthen documentation.