CPT 97607Physical Therapy

Neg prs wnd thr ndme<=50sqcm

CPT 97607 covers negative pressure wound therapy (also called vacuum-assisted wound closure) for wounds measuring 50 square centimeters or less. This treatment uses controlled suction to help chronic or difficult wounds heal by removing fluid and promoting tissue growth.

Showing rates for

National Average

Base Medicare rate

$323.14

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

0.41

PE RVU (NF)

9.53

MP RVU

0.05

Total RVU

9.99

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

NCCI bundling edits

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Billing tips

Verify place of service designation carefully: bill with POS 11 (office) to receive $323.14 versus POS 22 (hospital outpatient) which pays only $20.38
Impact: $302.76 difference per treatment (93.7% higher reimbursement in non-facility setting)
Measure and document exact wound dimensions in square centimeters before each application; if wound exceeds 50 sq cm, must bill 97608 instead which has different reimbursement
Impact: Prevents downcoding denials and ensures appropriate code selection; improper measurement is the #1 audit trigger for this code family
Submit with appropriate ICD-10 codes specifying wound location, type (pressure, diabetic, etc.), and laterality; link diagnosis codes that support medical necessity for NPWT
Impact: Claims without specific wound etiology codes face 40-60% denial rates; proper coding ensures medical necessity is established
Do not bill 97607 on the same date as debridement codes (11042-11047) for the same wound without modifier 59 and clear documentation of separate procedures
Impact: Prevents bundling denials; without modifier 59, expect automatic denial due to NCCI edits
Bill only once per wound per day regardless of dressing adjustment frequency; if treating multiple wounds totaling ≤50 sq cm, bill 97607 once unless wounds are at distinctly separate anatomical sites
Impact: Over-billing multiple units per day results in 100% denial of duplicate charges and potential audit flags
For therapy providers, ensure compliance with PT/OT caps and append modifier KX when exceeding thresholds with documented medical necessity

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 97607 in 2025?

The 2025 Medicare national average reimbursement for CPT 97607 is $323.14 in non-facility settings (physician offices, independent clinics) and $20.38 in facility settings (hospital outpatient departments). The significant difference reflects practice expense costs included in the non-facility rate for equipment and supplies.

How many times can I bill CPT 97607 per day?

CPT 97607 should typically be billed only once per day per wound site. If treating multiple distinct wound sites on the same day, each at separate anatomical locations (e.g., right foot and left leg), you may bill 97607 with appropriate modifiers (LT/RT, 59) for each site. However, multiple wounds in the same general area that are treated as a single wound care session should be billed as one unit.

What is the difference between CPT 97607 and 97608?

The only difference is wound size: CPT 97607 is for wounds measuring 50 square centimeters or less, while CPT 97608 is for wounds greater than 50 square centimeters. Accurate measurement and documentation of wound dimensions is critical for proper code selection. Both codes describe the same negative pressure wound therapy procedure.

Can physical therapists bill CPT 97607?

Yes, physical therapists can bill CPT 97607 when providing negative pressure wound therapy within their state scope of practice and when they have appropriate training and competency. Medicare requires the service to be medically necessary and part of a physical therapy plan of care. Physical therapists must append modifier GN or GP and ensure compliance with therapy cap thresholds.

What diagnosis codes support medical necessity for CPT 97607?

Appropriate ICD-10 codes include specific wound types such as diabetic ulcers (E11.621-E11.622), pressure ulcers (L89.xxx with stage specification), venous stasis ulcers (I83.xxx), arterial ulcers (I70.26x), surgical wound dehiscence (T81.31xA), and traumatic wounds (various S-codes). The diagnosis code must specify wound location, laterality, and type. Non-specific wound codes or lack of etiology often result in medical necessity denials.

Does CPT 97607 include the cost of the NPWT device and supplies?

In non-facility settings, the $323.14 payment includes the practice expense for disposable supplies and equipment use during the session. However, if a durable NPWT device is sent home with the patient, the device itself is typically billed separately using HCPCS codes (E2402) and subject to different coverage rules, often through DME suppliers. The 97607 code covers only the professional service of applying and managing the therapy during the visit.

Can I bill an E/M code on the same day as CPT 97607?

Yes, you can bill an E/M service (99202-99215) on the same day as 97607 if the E/M service is significant and separately identifiable from the wound care procedure. The E/M code must be appended with modifier 25, and documentation must clearly show the E/M service addressed issues beyond the wound care or involved separate medical decision-making. The wound therapy alone does not justify a separate E/M code.