CPT Code 97605: Complete Guide to Billing, Usage, and Reimbursement
CPT Code 97605 refers to Negative Pressure Wound Therapy (NPWT), performed on a wound area of less than or equal to 50 square centimeters, using a disposable (non-durable) device. This code is essential for medical billing and clinical documentation when treating chronic wounds, ulcers, surgical sites, or traumatic injuries requiring negative pressure treatment.
How CPT Code 97605 is Defined in Medical Billing
The American Medical Association (AMA) defines CPT 97605 as:
“Negative pressure wound therapy (e.g., vacuum-assisted drainage collection), utilizing durable medical equipment, including topical application(s), wound assessment, and instruction(s) for ongoing care, per session, total wound(s) surface area ≤ 50 sq cm.”
This code is specifically used when:
- The total wound size is 50 sq cm or smaller.
- The procedure is performed using a single-use or disposable NPWT device.
How CPT 97605 Differs from CPT 97606 and Other NPWT Codes
CPT codes 97605 and 97606 both describe Negative Pressure Wound Therapy (NPWT) utilizing Durable Medical Equipment (DME), but they are differentiated by total wound surface area. Code 97605 is for wounds ≤50 square centimeters, whereas 97606 is for wounds greater than 50 square centimeters.
| Code | Description | Wound Size | Device Type |
| 97605 | NPWT ≤ 50 sq cm | ≤ 50 sq cm | Disposable |
| 97606 | NPWT > 50 sq cm | > 50 sq cm | Disposable |
| 97607 | NPWT ≤ 50 sq cm | ≤ 50 sq cm | Durable |
| 97608 | NPWT > 50 sq cm | > 50 sq cm | Durable |
CPT 97605 is specifically for smaller wounds using a disposable device, while 97606 covers larger wounds. Correct coding prevents claim denials.
How Negative Pressure Wound Therapy Works
Negative pressure wound therapy promotes healing by applying sub-atmospheric pressure to a wound bed through a sealed dressing. The process:
- Debridement and Cleaning – The wound is thoroughly cleaned.
- Application of Foam or Gauze – A sterile foam or gauze dressing is applied.
- Sealing with an Adhesive Film – A vacuum-sealed film covers the wound.
- Vacuum Activation – The device creates negative pressure to remove exudate and improve blood flow.
How to Determine Medical Necessity for CPT 97605
Medical necessity is key for reimbursement. Use CPT 97605 when:
- The patient has chronic, non-healing wounds (diabetic ulcers, venous ulcers).
- There is a need for continuous drainage of exudate.
- The wound has failed standard care.
Documentation Must Include:
- Wound measurements (length, width, depth).
- Type of wound (e.g., diabetic ulcer, pressure ulcer).
- Physician’s order specifying NPWT.
How to Correctly Bill for CPT 97605
To correctly bill for CPT 97605, you must ensure the Negative Pressure Wound Therapy (NPWT) was performed on an open wound ≤50 cm2 using Durable Medical Equipment (DME). Thorough documentation of the wound size, medical necessity, and type of equipment used is essential for reimbursement.
Billing CPT 97605 requires:
- Single Unit Per Session – Bill per encounter, not per wound.
- Modifiers – Use modifier 59 if multiple sessions occur on the same day.
- Frequency Limits – Most payers allow up to 15 sessions per month.
Sample Billing Table:
| Field | Entry Example |
| CPT Code | 97605 |
| Units | 1 |
| Diagnosis Code | L97.421 (Non-pressure chronic ulcer of left heel) |
| Modifier | 59 (if multiple) |
How to Document CPT 97605 for Maximum Reimbursement
Accurate documentation ensures claim approval. Includes following for maximum reimbursement.
- Patient demographics and wound location.
- Pre-treatment wound assessment.
- Negative pressure settings and duration.
- Post-procedure evaluation.
How to Avoid Common Billing Errors with CPT 97605
| Common Error | Impact | Prevention |
| Using CPT 97605 for wounds > 50 sq cm | Claim denial | Use CPT 97606 |
| Missing wound size documentation | Payment delay | Always measure |
| Using durable NPWT device but billing 97605 | Audit risk | Verify device type |
How Medicare and Private Payers Reimburse CPT 97605
Reimbursement rates vary by payer and region. As of 2025:
| Payer | Average Reimbursement |
| Medicare | $105 – $125 per session |
| Private Insurance | $120 – $160 per session |
How CPT 97605 Fits Into Wound Care Treatment Plans
CPT 97605 represents Negative Pressure Wound Therapy (NPWT) using Durable Medical Equipment (DME) for smaller wounds (≤50 cm2), positioning it as an advanced intervention. It is typically utilized after conservative treatments fail and is billed per session, often alongside debridement codes. CPT 97605 is typically part of a multi-week wound care regimen.
- Initial Phase: Debridement and dressing changes.
- Maintenance Phase: Regular NPWT sessions until closure.
- Follow-Up: Assessment of tissue growth and infection control.
How to Combine CPT 97605 with Other CPT Codes
CPT 97605 can be billed alongside:
- 97597/97598 (Debridement)
- 11042–11047 (Excisional debridement)
- A6550/A7000 (Supply codes)
How Providers Can Stay Compliant with CPT 97605
- Follow Local Coverage Determinations (LCDs) by Medicare.
- Obtain prior authorization when required.
- Keep detailed wound progress notes.
How Technology Improves CPT 97605 Applications
Newer NPWT systems are:
- Portable and Disposable – Single-use devices reduce infection risk.
- Digitally Monitored – Some systems track pressure in real time.
- Cost-Effective – Lower equipment maintenance.
How CPT 97605 Impacts Patient Outcomes
Studies show that NPWT with CPT 97605 leads to:
- 40% faster healing rates in diabetic ulcers.
- Lower infection rates compared to standard dressings.
- Reduced hospital stays, cutting overall healthcare costs.
How to Appeal Denied CPT 97605 Claims
If a claim is denied:
- Review denial codes.
- Submit corrected documentation (wound size, photos).
- File an appeal with supporting medical records.