What is CPT 97608 — short answer
Active wound care management by topical application and/or negative pressure therapy, including provision of single-use disposable, non-durable medical device for NPWT; per session; total wound(s) surface area greater than 50 square centimeters (cm²). In plain language: this code is used when a practitioner provides a single-use NPWT session for wounds whose combined surface area is > 50 cm².
Clinical background — why NPWT is used
Pressure wound therapy (NPWT) applies controlled subatmospheric pressure to a wound through a sealed dressing to remove exudate and infectious material, reduce edema, promote perfusion, and help approximate wound edges, all intended to hasten healing of slow/non-healing wounds (e.g., diabetic foot ulcers, pressure injuries, large traumatic wounds). Payer medical policies (commercial and Medicare MACs) generally require documentation showing NPWT is medically necessary (chronicity, failure of simpler therapy, appropriate wound measurements, and expected benefit).
CPT family: 97605–97608 (quick comparison table)
| Code | What it represents | Wound area rule | Billing unit |
| 97605 | Negative pressure wound therapy using durable device (often rental DME pump) | N/A (durable NPWT) | Per day or per DME rules |
| 97606 | Active wound care management, topical application (non-NPWT) | N/A | Per session |
| 97607 | NPWT with single-use disposable device; total wound area ≤ 50 cm² | ≤ 50 cm² | Per session. Use for small wounds. |
| 97608 | NPWT with single-use disposable device; total wound area > 50 cm² | > 50 cm² | Per session. Use for larger wounds. |
Billing fundamentals for CPT 97608 — units, frequency, POS
Unit of service: 97608 is reported per session. Most payers expect one unit per treatment session (one dressing change/application of NPWT system). Do not multiply units if multiple wounds are treated in the same session — combine wound areas for the total area and bill a single unit.
Place of Service (POS): 97608 can be furnished in a variety of settings (outpatient clinic, wound center, hospital outpatient, home health in some cases) — but policies differ by payer and setting. OPPS/Medicare payment for single-use NPWT can be assigned to APC groups, and status indicators may affect multiple-procedure reductions. Check the MAC LCD for the jurisdiction.
Frequency: Payers expect medically reasonable frequency (e.g., sessions every 24–72 hours depending on dressing and wound). Excessive frequency can trigger medical necessity reviews. Document clinical rationale for any deviation from typical frequency.
Documentation checklist — the single best way to avoid denials
Make these elements part of every NPWT session note. Think of this as a “must-have” audit bundle:
- Wound measurement — length × width (cm) for each wound, depth if relevant. Then calculate total surface area (cm²) across all wounds and state explicit number (e.g., “Total wound surface area = 68 cm²”). (This determines 97607 vs 97608.)
- Wound description & diagnosis — ICD-10 code(s) linked to the CPT code (e.g., L97.421: nonpressure chronic ulcer of right heel). Use highest specificity.
- Indication & medical necessity — why NPWT is needed (failed conventional therapy, excessive exudate, wound complexity, infection control, etc.). Include prior treatments and outcomes.
- Procedure details — type of device (single-use disposable NPWT), dressing components, suction level, duration applied during session, and who applied it (MD/RN/LPN). If the device was provided, document that a single-use system was supplied.
- Clinical assessment — wound progress, presence of infection, granulation tissue, surrounding skin status.
- Patient/family instructions — wound care teaching and plan.
- Frequency plan and goals — expected duration of NPWT, measurable goals (e.g., reduce wound area by X% in Y weeks).
- Linkage: Link the ICD-10 code(s) to the CPT code on the claim form and ensure consistent documentation.
Step-by-step: How to bill CPT 97608 accurately (practical workflow)
- Before the visit: verify payer coverage/policy for NPWT (does the insurer cover single-use NPWT, is prior authorization required?). Some payers require prior auth; some accept retrospective review but will deny if not documented.
- At the visit: measure wounds precisely (cm), calculate total area, document device used (single-use disposable pump), and document clinical rationale for NPWT. State total wound area explicitly in the note (e.g., “Total area = 82 cm² — CPT 97608 applies”).
- Coding decision: if total area >50 cm² → bill 97608; ≤50 cm² → 97607. Only one of these should be billed per session (combine multiple wounds).
- Modifiers & simultaneous services: if an E/M or other procedure is performed the same day, determine bundling rules. For commercial payers and Medicare MACs, NPWT may or may not be separately payable with E/M depending on documentation and place of service — document the medical necessity for both and append appropriate modifier (e.g., modifier 25 for a significant, separate E/M) only when the E/M meets the criteria. For hospital outpatient vs office, check OPPS/MAC guidance.
- Claim submission: link the correct ICD-10 code(s) to CPT 97608 in claim fields; report POS appropriately; attach prior auth info when available. Include device HCPCS/NDC charges when billing for supplies (follow payer-specific DME/HCPCS rules).
- If denied: use appeal language (see section 7) and attach the exact session note showing area >50 cm² and medical necessity. Appeals succeed frequently when the documentation gap is closed.
Common denials and precise fixes (with sample appeal language)
Common denial reasons
- Insufficient documentation of wound area or total area not shown — payer says wrong code (97607 vs 97608) or no medical necessity. Fix: produce the original note with measurements and total area calculation.
- Missing link to ICD-10 or medical necessity not established — e.g., no prior conservative therapy shown or missing reason for NPWT. Fix: supply prior notes showing failed conservative care and a clear statement of why NPWT is indicated.
- Service billed for inappropriate place of service or wrong payer rules (DME vs single-use device confusion) — some claims incorrectly bill durable NPWT code instead of disposable code. Fix: clarify that the device was single-use/disposable and cite invoice, device label, or KX/HCPCS when needed.
- Frequency too high or beyond policy limits — payer may deny as not medically necessary. Fix: provide clinical rationale and notes supporting frequency (e.g., heavy exudate required >1 dressing change every 48 hours).
Advanced billing scenarios & problem solving
- Multiple wounds same day
- Rule: Add areas of all wounds treated in the session to determine total area. Do not bill separate 97607/97608 for each wound; instead bill a single code based on combined total. Example: three wounds sized 10, 20, 25 cm² → total 55 cm² → bill 97608.
- Debridement and NPWT same day
- Rule: Surgical debridement (CPT 11042–11047) and NPWT may both be clinically necessary. Payer policies differ on bundling — document that debridement was a separate, distinct procedure and that NPWT began after debridement and was clinically necessary to manage exudate. Use modifier 59 or X{E,P,S} series only if payer accepts it and clinical circumstances meet the standard. Always check MAC/LCD guidance.
- E/M visit same day
- Rule: If an E/M meets the criteria for a significant, separately identifiable service, append modifier 25 and document the E/M distinctly (history, exam, medical decision making) separate from the procedure note. Some payers may still bundle; include robust documentation.
- Durable NPWT vs single-use NPWT
- Rule: Commercial payers and Medicare differentiate between durable pump rental (often billed under DME rules / HCPCS for durable pumps) and single-use disposable systems billed with CPT 97607/97608. Submitting the wrong code family will lead to denials. Use invoices/device labels in appeals.
- Home health & DME interplay
- Home health agencies may supply NPWT under home health benefit if criteria met, while suppliers bill DME. Coordination with DME suppliers and correct use of CPT vs HCPCS is essential — check MAC and DME policy for durable pump coverage.
Payer landscape & 2025–2026 outlook (what changed / expected)
2025 highlights
- Medicare OPPS / APC assignments: Single-use NPWT codes (97607/97608) continue to be assigned to APC groups (e.g., APC 5052 Level II) for OPPS billing with status indicators that may subject them to multiple procedure reductions. Check the CY2025 OPPS final rule and your hospital billing team for exact APC and status indicator details.
- MAC/LCD scrutiny on medical necessity: MACs continue to emphasize documentation of wound size, failure of conservative therapy, medically necessary frequency, and ICD-10 linkage.
- Commercial payers: Large national payers (UHC, Aetna, Cigna) maintain clinical policy bulletins for NPWT that require demonstration of chronic/nonhealing wounds, exudate levels, and documentation of device type — these policies were reaffirmed or updated in 2024–2025. Expect continued prior authorization requirements for many commercial plans.
When to use 97607 vs 97608
| Situation | Total wound area | Correct CPT |
| Single small wound 3 × 4 cm (12 cm²) | 12 cm² | 97607 |
| Two wounds 25 + 30 cm² (total 55 cm²) | 55 cm² | 97608 |
| One wound 60 cm² | 60 cm² | 97608 |
ICD-10 examples commonly used with NPWT (examples only; choose highest specificity)
| Clinical scenario | Example ICD-10 |
| Diabetic foot ulcer, right great toe | E11.621 |
| Pressure ulcer, sacral stage 3 | L89.153 |
| Non-pressure chronic ulcer, left lower leg | L97.324 |
Modifier rules (common)
| Modifier | Use case |
| 25 | Significant, separately identifiable E/M on same day — only if E/M meets criteria and documented separately. |
| 59 / XS / XP / XU / XE | Use to indicate distinct procedure when bundling edits would otherwise combine services — use sparingly and with documentation. |
| RT / LT | Do NOT use to change 97607/97608 choice — area is combined across wounds, not by laterality alone |
How do I bill CPT 97608 accurately to avoid denials?
A: Measure and document total wound area (explicit number), show medical necessity (failed conservative care or specific rationale), document that a single-use NPWT system was used, choose 97608 only when total area >50 cm², link correct ICD-10(s), check for prior auth, and include device proof if needed. Use modifier 25 only when E/M qualifies. (See full checklist above.)
Q: Outlook and 2025/2026 updates?
A: In 2025 payers continued to emphasize clear documentation of area and medical necessity and maintain APC assignments for single-use NPWT in OPPS. Expect continued utilization management and more prior auth workflows entering 2026 — practices should standardize wound-measurement documentation and pre-auth processes.
Q: Advanced billing problem solving?
A: See section 8 — cover multi-wound math, DME vs CPT differences, same-day debridement/E&M interactions, and appeals language with device invoice attachments.