CPT 97598Physical Therapy

Dbrdmt opn wnd addl 20cm/<

CPT code 97598 is used when a healthcare provider removes dead tissue, debris, or contaminated material from an open wound, covering each additional 20 square centimeters beyond the first area treated.

Showing rates for

National Average

Base Medicare rate

$43.34

This calculator gives a typical-case estimate using standard Medicare modifier rules. Actual payment depends on payer policies, documentation, code-specific CMS status indicators, and locality. Verify before billing.

RVU breakdown

Work RVU

0.5

PE RVU (NF)

0.79

MP RVU

0.05

Total RVU

1.34

Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High

NCCI bundling edits

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Billing tips

Calculate total wound surface area accurately in square centimeters before coding; bill 97597 for the first 20 sq cm, then 97598 for each additional 20 sq cm or portion thereof
Impact: Undercoding by even one unit of 97598 results in $43.34 lost revenue per missed 20 sq cm increment in non-facility settings
Document the exact surface area measurement (length × width) for each wound debrided, as this is the #1 audit target for wound debridement codes
Impact: Missing measurements result in 60-80% denial rates on appeal; proper documentation protects $43.34 per unit billed
Never bill 97598 without also billing the primary code 97597 on the same claim; 97598 is an add-on code and will auto-deny without its parent code
Impact: 100% denial if billed alone; this is a hard edit in Medicare systems and most payer scrubbers
When debriding multiple separate wounds, add the total surface area together to determine units; do not bill separately per wound unless using modifier 59 for distinct sites
Impact: Incorrect unit calculation can lead to either underbilling (lost revenue of $43.34 per unit) or overbilling (audit risk and recoupment)
Verify that debridement is selective (not excisional) and involves removal of devitalized tissue; excisional debridement requires surgical codes (11042-11047) with higher reimbursement
Impact: Using 97598 instead of appropriate surgical debridement codes can result in underpayment of $100+ per procedure
Bill on the date of service, not the evaluation date; some payers limit frequency to once per week or require medical necessity documentation for more frequent debridement

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Frequently asked questions

What is CPT code 97598 used for?

CPT 97598 is an add-on code used to bill for selective debridement of each additional 20 square centimeters (or portion thereof) of an open wound beyond the first 20 square centimeters covered by code 97597. It covers removal of dead tissue, debris, and contaminated material using instruments like scissors, forceps, or high-pressure waterjet.

How much does Medicare pay for CPT 97598 in 2025?

Medicare pays $43.34 for CPT 97598 in non-facility settings and $23.29 in facility settings based on the 2025 national average rates. Actual payment may vary by geographic location based on locality-specific adjustments.

Can CPT 97598 be billed alone without 97597?

No, CPT 97598 is an add-on code and cannot be billed alone. It must always be billed with the primary debridement code 97597 on the same claim. Billing 97598 without 97597 will result in automatic denial.

How do you calculate units for CPT 97598?

Calculate the total wound surface area in square centimeters (length × width). Bill 97597 for the first 20 sq cm, then bill one unit of 97598 for each additional 20 sq cm or portion thereof. For example, a 65 sq cm wound requires 97597 × 1 and 97598 × 3 units.

What is the difference between CPT 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 square centimeters beyond the first. Both represent the same type of debridement procedure but differ in the amount of surface area covered.

How often can CPT 97598 be billed for the same patient?

There is no absolute Medicare frequency limit, but medical necessity must be documented for each service. Many payers limit reimbursement to 1-3 times per week. More frequent debridement requires clear documentation of clinical need such as infection, heavy exudate, or rapid necrotic tissue accumulation.

What documentation is required to bill CPT 97598?

Required documentation includes exact wound measurements in centimeters showing total surface area, wound location, type of tissue removed, debridement method used, medical necessity justification, and patient response. Missing wound measurements in square centimeters is the most common reason for claim denial and audit recoupment.