Negative pressure wound therapy (NPWT) using durable medical equipment for wounds with a total surface area of 50 square centimeters or less.

Verified May 8, 2026 · 5 sources ↓

Medicare: $42.09
Work RVU: 0.54
Global, days
Region: General

Drawn from CMS

Documentation requirements

What must appear in the operative or office note to support the claim.

Source · Editorial brief grounded in 5 cited references ↓

Wound surface area measurement confirming ≤50 cm² before NPWT application
Medical necessity justification specific to NPWT — document why standard wound care is insufficient
NPWT device settings including suction pressure used during the session
Description of wound bed, exudate type and volume, and wound response to therapy
Type of dressing applied and confirmation of sealed placement
ICD-10-CM diagnosis code linked to 97605 at the highest level of specificity

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

25 Significant separate E/M 59 Distinct service 76 Repeat, same physician 77 Repeat, another physician KX Documentation on file LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

97605 covers the application of controlled subatmospheric (negative) pressure to a wound site using a DME-classified device — a sealed dressing connected to a suction unit that evacuates fluids and infectious material to promote healing. The defining threshold is wound surface area: 50 cm² or less. Exceed that and you're in 97606 territory. The global period is XXX, meaning standard global bundling rules don't apply and the service is priced per encounter.

The code bundles in the placement and removal of any protective or bulk dressings associated with the NPWT device. Don't unbundle a separate dressing change code for the same wound on the same date. If only a dressing change is performed — no active NPWT application — 97605 cannot be reported. The code appears most frequently in Orthopedic Surgery, General Surgery, and Plastic and Reconstructive Surgery billing contexts.

Prior authorization is payer-variable for NPWT. Medicare coverage is governed by LCD L35125 and its associated billing article A53001. ICD-10-CM codes must reflect the clinical reason for NPWT and be linked to 97605 at the highest specificity level. When billing 97605 on the same date as an E/M, append modifier 25 to the E/M to establish a separately identifiable service.

RVU & reimbursement

Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU vs. total RVU

The work RVU (0.54) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (1.26) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	0.54
Practice expense RVU	0.71
Malpractice RVU	0.01
Total RVU	1.26
Medicare national rate	$42.09
Global period	days

Payment by site of service

Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.

Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026

Setting	Medicare rate (national)
Office (PFS non-facility) Procedure performed in physician's office	$42.09
HOPD (APC 5051) Hospital outpatient department	$204.98

Common denial reasons

The recurring reasons claims for CPT 97605 get rejected.

Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓

Wound size not documented or documented measurement exceeds 50 cm², triggering a mismatch with 97605
Dressing change only performed with no active NPWT application — 97605 cannot be billed for dressing changes alone
Missing or inadequate medical necessity documentation under LCD L35125 requirements
Prior authorization absent when required by the payer for NPWT services
ICD-10-CM diagnosis code not coded to highest specificity or not linked to 97605 on the claim

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 5 cited references ↓

01What separates 97605 from 97606?

Surface area is the only distinction. 97605 applies when the wound is 50 cm² or less. 97606 applies when the wound exceeds 50 cm². Measure and document before you bill — auditors look for this.

02Can 97605 be billed with an E/M on the same date?

Yes, but append modifier 25 to the E/M code. The E/M must be separately identifiable from the NPWT service and documented as such in the note.

03Does 97605 include the dressing removal and replacement?

Yes. Protective and bulk dressings associated with the NPWT device are bundled into 97605. Do not separately bill a dressing change code for the same wound on the same date.

04Does Medicare require prior authorization for 97605?

Medicare coverage is governed by LCD L35125. Some MACs require prior authorization or have coverage criteria tied to wound type and prior treatment failure. Check your MAC's local policy before submitting.

05When should modifier 59 be used with 97605?

Use modifier 59 when NPWT is applied to a distinct wound site on the same date as another wound procedure, to establish that the services were performed on separate, non-overlapping wounds.

06Can 97605 be billed during the global period of a surgical procedure?

97605 carries a XXX global indicator, so standard surgical global bundling doesn't attach to this code itself. However, if NPWT is applied during the global period of a related surgical procedure, payer policies vary — some MACs consider wound care a routine post-op service. Modifier 24 on the E/M or documentation of an unrelated condition may be required depending on the scenario.

07What ICD-10-CM codes are typically paired with 97605?

Common pairings include chronic ulcer codes (L89.xx for pressure ulcers, L97.xx for non-pressure lower extremity ulcers), traumatic wound codes, and post-surgical wound complication codes. The diagnosis must reflect the actual clinical reason for NPWT and be coded to the highest specificity.

Sources & references

Editorial content was developed using the following public sources. Last verified May 8, 2026.

01CMS Physician Fee Schedule 2026
02CMS Billing and Coding: Wound Care, Article A53001 — https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleID=53001
03CMS Billing and Coding: Wound and Ulcer Care, Article A58565 — https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=58565
04CMS Medicare NCCI Policy Manual — https://www.cms.gov/medicare/coding-billing/national-correct-coding-initiative-ncci-edits/medicare-ncci-policy-manual
05CMS Medicare NCCI Edits — https://www.cms.gov/medicare/coding-billing/national-correct-coding-initiative-ncci-edits

Mira Scribe

Mira's AI scribe captures wound location, measured surface area (in cm²), NPWT device suction pressure settings, dressing type, exudate characteristics, and the clinical rationale for NPWT over standard wound care — all from dictation at the point of care. That structured capture prevents the most common 97605 denial: a missing or vague wound measurement that can't confirm the ≤50 cm² threshold.

See how Mira captures CPT 97605 documentation