CPT 97607
Updated 5/6/2025
Reviewed by Nathan Liu, MD

Negative pressure wound therapy for wounds ≤50 cm²

Description

This procedure involves the application of controlled subatmospheric pressure to promote healing in wounds with a total surface area of 50 cm² or less. It is particularly effective for treating slow or nonhealing wounds, including decubitus ulcers and other pressure sores, by removing fluids and infectious materials to facilitate recovery.

Medicare Provider Reimbursement (PFS)

Facility Setting

Procedure Price$20.38
Limiting Charge$22.26
Patient Coinsurance (20%)$4.08

RVU Calculation Breakdown

Work RVU
0.41
Practice Expense RVU
0.17
Malpractice RVU
0.05
Total RVU
0.63
0.41 + 0.17 + 0.05 = 0.63
0.63 RVUs×$32.3465 Conversion Factor
$20.38

Non-Facility Setting

Procedure Price$323.14
Limiting Charge$353.03
Patient Coinsurance (20%)$64.63

RVU Calculation Breakdown

Work RVU
0.41
Practice Expense RVU
9.53
Malpractice RVU
0.05
Total RVU
9.99
0.41 + 9.53 + 0.05 = 9.99
9.99 RVUs×$32.3465 Conversion Factor
$323.14

Medicare Patient Copayment

After meeting the annual Medicare deductible ($1676 per benefit period up to 60 days for inpatient stays under Part A and $257 for outpatient care under Part B in 2026), Medicare patients are typically responsible for 20% of the Medicare-approved amount as coinsurance. The amounts shown are estimates and may vary based on the patient's specific coverage and whether they have supplemental insurance.

Medicare Hospital Outpatient Reimbursement (OPPS)

OPPS Payment Rate

$399.53

Calculation:

x=$399.53

Patient Copayment / Coinsurance

$79.91

Calculation breakdown:

  • Minimum (20% of rate)$79.91
Top Modifiers

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HCPCS/CPT 59Distinct procedural service for non-E/M services(22.08%)
HCPCS/CPT GCServices performed by a resident under the supervision of a teaching physician(7.27%)
HCPCS/CPT LTModifier for procedures performed on the left side of the body(6.85%)
HCPCS/CPT RTRight side procedure modifier(6.43%)
HCPCS/CPT 58Staged or related procedure by the same physician during postoperative period(5.52%)
HCPCS/CPT XUUnusual non-overlapping service(4.83%)
HCPCS/CPT XSSeparate structure service on distinct organ or structure(2.51%)
HCPCS/CPT GWService unrelated to hospice patient's terminal condition(2.25%)
HCPCS/CPT GPOutpatient physical therapy service delivered by a physical therapist(2.13%)
HCPCS/CPT 79Unrelated procedure by the same physician during the postoperative period(1.37%)
Code Crosswalks

No crosswalks found.

Alternate Codes

No alternates found.

Billed With Codes

No codes found here.

Sources

We make no claims to ownership of the coding systems referenced on this platform. Codes and descriptions are produced from claims and chargemaster data available through the CMS-9915-F Transparency in Coverage Final Rule and via state or federal datasets. This service is provided solely as a reference to encourage use of these codes in our chargemaster review and automated billing tools, so that healthcare professionals can understand and correctly report these codes in their claims.

Federal and State Datasets

  • List of CPT/HCPCS Codes, Centers for Medicare & Medicaid Services (CMS)
  • I/OCE Quarterly Release Files, Centers for Medicare & Medicaid Services (CMS)
  • Physician Fee Schedule Relative Value Files, Centers for Medicare & Medicaid Services (CMS)
  • OPPS Addendum B, Centers for Medicare & Medicaid Services (CMS)
  • ASC Payment Addenda, Centers for Medicare & Medicaid Services (CMS)