What is CPT 97606?
CPT® 97606 is an active wound care management code for negative pressure wound therapy (NPWT) where durable (non-disposable) equipment is used and the total wound surface area is greater than 50 square centimeters. It represents the application of a sealed dressing connected to a suction pump (vacuum-assisted closure) using durable devices, with wound assessment, topical application(s), and instruction for ongoing care performed per session.
How 97606 differs from related NPWT codes — comparison table
| CPT/HCPCS | When to use | Equipment type | Wound size threshold | Typical billing scenario |
| 97605 | NPWT using durable equipment | Durable (non-disposable) | ≤ 50 cm² | Small wound VAC using clinic-owned pump. |
| 97606 | NPWT using durable equipment | Durable (non-disposable) | > 50 cm² | Larger wounds requiring durable pump and canister. |
| 97607 | NPWT using disposable (single-patient) system | Disposable (pump + canister included) | ≤ 50 cm² | Disposable dressings/pump supplied to patient; includes device components. |
| 97608 | NPWT using disposable system | Disposable | > 50 cm² | Larger wounds with disposable NPWT systems. |
Why size matters: CPT distinguishes session codes by total wound surface area — accurate measurement (length × width; document in cm) is required to choose 97605/97606 vs 97607/97608. Failure to document size is a frequent reason for denials or retrospective downcoding.
Why correct coding and documentation matter (clinical + revenue impact)
How small documentation gaps create big problems:
- Clinical continuity: documenting wound size, progress, and prior treatments informs appropriate NPWT duration.
- Revenue protection: NPWT codes (97605–97608) often pay materially more than simple dressing changes; incorrect use (e.g., using a dressing-change code only) loses revenue.
- Compliance and denials: payers (including Medicare) have clear rules about when NPWT codes are reportable (e.g., not when used as simple dressing over a closed incision) — misbilling invites denials and recoupments.
How to bill CPT 97606 accurately to avoid denials — step-by-step checklist
Step 1 — Verify that NPWT is medically necessary for this wound
- Document wound etiology, prior conservative treatments tried (e.g., advanced dressings, off-loading), and reason NPWT is selected (exudate management, promote granulation, decreased edema). Payers often require prior conservative care documentation.
Step 2 — Measure & document total wound surface area (cm²)
- Measure longest length × widest width of the wound(s). If there are multiple wounds in the same anatomical region and you will treat them in a single session, document combined total surface area and list each wound with its measurements. This determines >50 cm² (use 97606) vs ≤50 cm² (use 97605).
Step 3 — Record the NPWT session details
- Explicitly document: application of a sealed dressing, attachment to durable pump, negative pressure applied (if available), assessment of wound, removal of any protective/bulk dressings, patient instruction, and estimated time on task (helpful for internal QA). CMS guidance notes these elements are included in the code.
Step 4 — Confirm equipment ownership / type
- If using clinic-owned (durable) pump that stays at the facility or is durable DME, use 97605/97606. If providing disposable unit and accessories to the patient (complete single-patient kit), use 97607/97608. Document exactly what components were used and whether a durable pump was used.
Step 5 — Check payer prior authorization & LCDs
- Many payers require prior authorization for NPWT or have Local Coverage Determinations (LCDs) with specific medical necessity criteria (e.g., failed conservative care, wound chronicity). Confirm and attach prior auth when applicable. Medicare Contractors’ MLN and LCDs list the rules.
Step 6 — Use correct modifiers when necessary
- Use modifiers for distinct services (e.g., modifier 59, X{E,P,S,T,U}, or RT/LT if applicable) carefully and sparingly — only when documentation supports a separate, distinct service. Do not append modifier 25 to these codes except in rare cases (not routine). Follow payer guidance.
Step 7 — Link diagnosis codes correctly
- Use ICD-10 codes that support NPWT (e.g., L97.x for chronic ulcers, S codes for acute traumatic wounds, and other specific wound/destruction codes). Ensure the diagnosis justifies NPWT per payer guidelines.
Step 8 — Monitor utilization & appeals
- Track claim outcomes and appeal timely for denials with supporting documentation (progress notes, photos, measurements, prior treatments). Many denials are won on appeal when good documentation exists.
Documentation checklist (table you can copy into chart notes)
| Item to document | Why it matters |
| Wound location and number | For accurate coding & later auditing |
| Exact measurements (length × width in cm) and total area (cm²) | Required to determine >50 cm² threshold for 97606 vs 97605 |
| Wound depth, tunneling, undermining (if present) | Clinical severity justification |
| Wound etiology (e.g., diabetic foot ulcer, pressure ulcer, surgical dehiscence) | Supports medical necessity |
| Prior conservative treatments & dates (dressings, off-loading, antibiotics) | Many payers require failed conservative care |
| Rationale for NPWT selection | Medical necessity statement |
| Type of NPWT equipment used (durable vs disposable) | Selects correct CPT family (9760x vs 97607/97608) |
| Details of application (seal, tubing, pump connected) | Confirms active NPWT procedure |
| Pressure setting and duration (if available) | Clinical detail and audit support |
| Patient education / instructions given | Part of the CPT description |
| Plan for next NPWT session and objective wound goals | Shows ongoing management and justification |
| Photographs (date-stamped) if allowed by facility policy | Visual support for progress and measurements |
Documentation strong enough to survive post-payment review includes objective measurements, dated photos, notes of prior failed therapies, and device specifics.
Common denials for CPT 97606 and immediate fixes
| Denial reason | Why it happens | Immediate fix / appeal tip |
| Insufficient documentation of wound size | Claim used 97606 (>50 cm²) but chart lacks measurements or total area | Supply measurement documentation, photos, or wound tracking sheet during appeal. Add combined area calc if multiple wounds. |
| NPWT used as dressing over closed surgical incision — not separately reportable | NPWT over closed incision sometimes considered dressing; payers may deny | Provide operative note, wound status, and clarify NPWT was used for an open wound requiring active therapy. Cite payer LCD that allows NPWT for certain closed incisions if applicable. |
| Wrong equipment type documented (disposable vs durable) | Billed durable code (97606) but records show disposable kit supplied | Provide documentation showing use of durable pump (clinic-owned) or refile with correct code (97608) and adjust charges. |
| Lack of prior conservative care documentation | Payer requires trial of conservative measures before NPWT | Submit prior treatment notes showing conservative measures and rationale for NPWT. For Medicare, cite LCD criteria if met. |
| Frequency / medical necessity denied for ongoing sessions | Payer questions continued need for repeated NPWT | Provide wound progress notes showing improvement or continued need and objective measurements; include plan with expected timeline. |
Advanced billing scenarios & problem solving
- Multiple wounds on same patient treated in one session — how to bill
How to calculate total area: sum the surface areas of all wounds in the treated region and document each wound’s measurements and the combined total. If combined area >50 cm² and durable NPWT used, 97606 is appropriate. If separate wounds in distinct anatomical regions treated independently, document rationale and consider payer guidance, sometimes payers expect one session code per treatment area.
- Post-operative closed incisions with NPWT — when is it reportable?
Why this is tricky: NPWT over a surgically closed incision can be considered either a dressing or an active therapy depending on clinical intent. Many MACs and payers treat NPWT over closed incisions as non-separately reportable unless specific medical necessity is documented (e.g., high risk of dehiscence, persistent drainage, seroma). Always review the applicable LCD/medical policy and document specific clinical rationale.
- Durable pump in clinic vs disposable kit to patient — coding consequences
- Durable pump (clinic-owned): bill 97605/97606 (sessions). Clinic typically bills for the procedure; DME supplier may bill separately if pump is supplied for home use under DME ordering rules.
- Disposable, single-patient kit supplied to patient: bill 97607/97608 which include the pump & canister in the code. Be careful: bundling rules differ and commercial payers may have different reimbursement for disposable systems. Document exactly what was given.
- Applying modifiers correctly — common scenarios
- Modifier RT / LT: append for laterality when distinct (e.g., two separate limb wounds). Some payers accept RT/LT with wound codes; check local rules.
- Modifier 59 / XA/XE/XP/XU: only when you can prove a distinct service (e.g., wound debridement 11043 and NPWT on same day but distinct anatomic sites). Use sparingly and have documentation ready for audit.
- Billing when NPWT pump is used but no active dressing change (e.g., check only)
If only a dressing check or simple dressing change without the procedural elements described in CPT 97606 (no application of active sealed dressing, no pump attachment), do not bill 97606. Instead bill appropriate simple dressing-change codes. The NPWT session codes include application and removal actions; if these weren’t performed, the code is not appropriate.
Payer policies & coverage rules — 2025 updates and 2026 outlook
What Medicare (CMS) guidance says
Medicare’s MLN and LCDs emphasize:
- NPWT codes include dressing application/removal and wound assessment; do not bill these for simple dressing changes.
- Accurate wound measurements and documentation of medical necessity (failed conservative care where required) are central to coverage decisions.
Notable 2025 trends (what changed or reinforced in payer policies)
- Increased specificity & prior authorization: In 2025 more commercial payers published clearer NPWT prior authorization pathways — UnitedHealthcare’s medical policy (updated July 2025) clarifies indications, objective wound criteria, and documentation expectations. This has led to more routine pre-auths in 2025.
- Consolidation of disposable vs durable coding expectations: Payers continue to emphasize the difference between 97605/97606 (durable) and 97607/97608 (disposable). Audit activity on this distinction increased in 2024–2025.
Outlook for 2026 — what to watch for
- Stricter medical-necessity auditing: Expect more retrospective audits focused on wound measurements, objective progress, and conservative therapy documentation. Keep clear baseline and interval measurements and photos.
- Value-based & outcomes focus: As payers emphasize outcomes, documentation that ties NPWT to measurable wound improvement (area reduction, depth) will support continued sessions and appeals. Consider implementing structured wound-tracking tools.
- Potential code use review: Pay attention to CPT Editorial changes announced late-2025 for 2026 CPT updates — these can refine descriptors or reporting rules. Subscribe to AAPC/CPT updates and local MAC alerts.
Coding examples and sample chart notes (copy/paste adaptable)
Example A — initial NPWT session, large diabetic foot ulcer
Problem: Diabetic foot ulcer, non-healing for 6 weeks.
Measurements: Wound #1 (plantar right forefoot) 6.5 cm × 3.0 cm = 19.5 cm²; Wound #2 (medial right plantar) 4.5 cm × 2.6 cm = 11.7 cm²; Combined total = 31.2 cm² → This example would be ≤50 cm² (97605) — shows how multiple wound math can change code. (Use this to illustrate importance of measurement.)
Example B — single large sacral pressure ulcer (use 97606)
Note template:
- HPI: 68-year-old with stage III sacral pressure ulcer present 3 months, failed conservative care (foam dressing changes x6 weeks), persistent heavy exudate, slough.
- Measurement: 8.0 cm × 7.5 cm = 60.0 cm² (measurements taken L×W in cm).
- Procedure: After debridement last visit, today applied sealed foam dressing, connected to clinic durable NPWT pump, set to -125 mmHg intermittent suction. Removed bulk dressing, inspected wound, irrigated, placed NPWT dressing, instructed patient/caregiver on system care and alarms. Plan: NPWT sessions 2–3× per week with reassessment in 7 days.
Billing: CPT 97606 for NPWT session (durable; >50 cm²). ICD-10: L89.153 (pressure ulcer sacral stage 3) — adjust to exact code.
KPIs & metrics to track for wound care billing success
- Denial rate for NPWT claims (target < 5%) — track by payer and denial reason.
- Average reimbursement per NPWT session (monitor changes by code 97605 vs 97606 vs 97607/97608).
- % of NPWT claims with prior authorization (measure whether pre-auths reduce denials).
- Time to appeal resolution (shorter is better; track wins on first appeal).
- Wound improvement rate / sessions to closure — clinical KPI that supports medical necessity and payer audits. Implement a wound registry spreadsheet or EMR wound flowsheet.
Top practical steps to reduce denials for 97606
- Measure and document wound dimensions and list combined area for multiple wounds. (Make it non-negotiable in every NPWT note.)
- Document prior conservative care and clear rationale for NPWT selection (date ranges, products used).
- Differentiate durable vs disposable systems in the chart; attach supply logs if a disposable kit was given.
- Prior authorize when payer requires — many denials are preventable by pre-auth.
- Use photos (date-stamped) when permitted by policy; they help appeals and quality review.
- Train your staff (nurses, coders, billers) on the >50 cm² rule and documentation expectations — simple measurement errors are common denial drivers.
FAQ’s About CPT Code 97606
How is CPT Code 97606 defined in medical billing?
CPT Code 97606 represents negative pressure wound therapy (NPWT) using durable (non-disposable) equipment for wounds with a total surface area greater than 50 cm². It covers the application of a sealed dressing, connection to a durable suction pump, wound assessment, and patient instruction performed per session.
How do I determine when to bill 97606 instead of 97605?
Use 97606 when the combined total wound surface area is over 50 cm² and a durable NPWT pump is applied. If the total surface area is 50 cm² or less, bill 97605. Always document exact measurements (length × width in cm) and the total combined area for multiple wounds.
How should documentation support CPT 97606 to avoid claim denials?
Your documentation must include:
- Wound location(s) and etiology
- Exact length, width, and total surface area in cm²
- Type of NPWT equipment (durable vs disposable)
- Details of dressing application, pump connection, and pressure settings
- Evidence of prior conservative treatments (if required by payer)
Without these details, claims are frequently denied or downcoded.
How do I measure and calculate wound size correctly for 97606?
Measure the longest length and widest width of each wound in centimeters. Multiply these to get surface area for each wound, then add all treated wounds together for the total area. If the total is greater than 50 cm², use CPT 97606. Always record each wound’s individual measurements and the combined total in the chart.
How is the NPWT equipment type documented and where should it be noted?
Clearly state in the procedure note whether a durable pump or a disposable single-patient system was used. This should be placed in the procedure description or equipment section of the medical record. The equipment type determines whether you bill 97605/97606 (durable) or 97607/97608 (disposable).
How can I bill CPT 97606 when multiple wounds are treated in one session?
Add the surface areas of all wounds treated in the same session to determine if the total exceeds 50 cm². Bill a single unit of 97606 if all wounds are treated with durable NPWT in one session. Document each wound’s individual size and the combined total to justify the code.
How do payers differ in covering CPT 97606 and where can I find their policies?
Medicare and commercial payers may have specific Local Coverage Determinations (LCDs) or medical necessity guidelines. These can be found on the CMS website, payer provider portals, or medical policy databases. Always review the payer’s latest policy for NPWT to confirm criteria such as conservative therapy requirements or prior authorization.
How do I use modifiers with CPT 97606 when other procedures are performed?
If NPWT is performed on the same day as a distinct procedure (like debridement at a different site), you may need modifier 59 or an X{E,P,S,T} modifier to indicate a separate and distinct service. Use these only when documentation clearly supports separate anatomical sites or independent procedures.
How often can CPT 97606 be billed and where is the frequency limit stated?
CPT 97606 can generally be billed per session, often multiple times per week depending on wound care needs. However, some payers set frequency limits (e.g., a maximum number of sessions per month). These limits are typically listed in payer-specific NPWT medical policies or prior authorization documents.
How will CPT 97606 reimbursement change in 2025 and 2026?
In 2025, many payers including Medicare contractors are tightening documentation and prior authorization requirements for NPWT. For 2026, industry experts expect stricter audits on wound size documentation and a stronger push toward value-based reimbursement that rewards documented wound healing progress. Staying updated with CPT Editorial Panel changes and payer policy updates will be essential for accurate billing.