CPT 97605Physical Therapy

Neg prs wnd ther dme<=50sqcm

CPT code 97605 covers negative pressure wound therapy (also called vacuum-assisted wound closure) for wounds measuring 50 square centimeters or smaller. This is a therapeutic procedure where controlled suction is applied to a wound to promote healing.

Showing rates for

National Average

Base Medicare rate

$42.05

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

0.55

PE RVU (NF)

0.74

MP RVU

0.01

Total RVU

1.3

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

NCCI bundling edits

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Billing tips

Distinguish between 97605 (professional application service) and DME codes A7000-A6550 (equipment/supplies). Bill 97605 for skilled application, assessment, and management; bill DME separately for pump rental and supplies.
Impact: Prevents $42.05 revenue loss per session; common error is billing only DME codes and missing the professional service component
Measure total wound surface area accurately before application. If wound exceeds 50 sq cm, use 97606 instead (pays $53.20 non-facility). Even 51 sq cm requires the higher code.
Impact: Proper measurement captures additional $11.15 per session when appropriate; undermeasurement leaves money on table
Document medical necessity clearly: wound dimensions, depth, exudate amount, tissue type, treatment duration, and clinical response. Medicare requires progress toward healing or prevention of deterioration.
Impact: Strong documentation reduces denial rate from 15-20% to under 5% based on audit data; protects $42.05 per session
Bill per session/encounter, not per day. If patient requires NPWT dressing change three times per week, bill 97605 three times weekly with proper documentation of skilled service at each visit.
Impact: Ensures full capture of all billable encounters; underbilling occurs when providers assume weekly limits that don't exist
Check facility vs. non-facility status carefully. In-office/clinic settings qualify for $42.05 non-facility rate; hospital outpatient departments receive only $23.61 facility rate.
Impact: Rate differential of $18.44 (44% difference) affects practice revenue projections and site-of-service planning
Coordinate with wound care physicians for appropriate ICD-10 codes. Link to specific wound etiology (L89.xx for pressure ulcers, E11.621 for diabetic foot ulcers) rather than generic codes.

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 97605 in 2025?

The 2025 Medicare national average reimbursement for CPT 97605 is $42.05 for non-facility settings and $23.61 for facility settings. Actual payment may vary by MAC locality and patient deductible/coinsurance status.

What is the difference between CPT 97605 and 97606?

CPT 97605 is for negative pressure wound therapy on wounds measuring 50 square centimeters or less, while 97606 is for wounds greater than 50 square centimeters. The wound size threshold determines which code to use, with 97606 reimbursing at a higher rate due to increased complexity.

Can CPT 97605 be billed with an E/M code on the same day?

Yes, but documentation must clearly support a separately identifiable evaluation and management service beyond the wound assessment inherent to NPWT application. Use modifier 25 on the E/M code and ensure documentation reflects distinct services. Many payers scrutinize this combination closely.

How often can CPT 97605 be billed for the same patient?

There is no specific Medicare frequency limit for 97605, but each session must be medically necessary and represent skilled service. Typical dressing change frequency is 2-3 times weekly, but clinical circumstances may justify different frequencies. Documentation must support the prescribed frequency.

Do physical therapists need physician supervision to bill CPT 97605?

Physical therapists can bill 97605 within their scope of practice and state licensure requirements. Medicare requires a physician certification of the plan of care, but not direct physician supervision during NPWT application. Use modifier GP to indicate PT service.

What RVU value does CPT 97605 have in 2025?

CPT 97605 has a total RVU of 1.30 in 2025, consisting of 0.55 work RVU, 0.74 non-facility practice expense RVU (0.17 facility PE RVU), and 0.01 malpractice RVU. These values multiplied by the conversion factor of 32.3465 determine Medicare payment.

Is CPT 97605 the same as billing for a wound VAC device?

No. CPT 97605 covers the professional service of applying and managing negative pressure wound therapy (including VAC devices), while the actual equipment rental and supplies are billed separately using DME codes (A6550, A7000, etc.). Both components should be billed when applicable - the professional service and the equipment.