HOPDs

2024 National Average Medicare Coding and Payment Rates for PICO sNPWT

The American Medical Association has established two CPT codes for Single Use Negative Pressure Wound Therapy (sNPWT): 97607 and 97608

CPT^® Code	Description	Status indicator	APC group	Total Medicare APC Allowable Payment Rate
97607	Negative pressure wound therapy (eg, vacuum assisted drainage collection), utilizing disposable, non-durable medical equipment including provision of exudate management collection system, topical application(s), wound assessment, and instructions for ongoing care, per session; total wound(s) surface area less than or equal to 50 square centimeters.	T	5052	$380.32
97608	Negative pressure wound therapy (eg, vacuum assisted drainage collection), utilizing disposable, non-durable medical equipment including provision of exudate management collection system, topical application(s), wound assessment, and instructions for ongoing care, per session; total wound(s) surface area greater than 50 square centimeters.	T	5052	$380.32

Medicare has assigned CPT codes 97607 and 97608 (single use negative pressure wound therapy) to Ambulatory Payment Classification (APC) Group 5052 Level II Debridement and Destruction with a status indicator of T (procedure or service subject to multiple procedure reduction), provided that the sNPWT service is medically necessary.

Please be sure to check with your patient’s individual health insurance provider to ensure coverage, coding, and payment requirements are met for the site of care and provider.

2023 National Average Medicare Coding and Payment Rates for PICO sNPWT

The American Medical Association has established two CPT codes for Single Use Negative Pressure Wound Therapy (sNPWT): 97607 and 97608

CPT^® Code: 97607

Description: Negative pressure wound therapy (eg, vacuum assisted drainage collection), utilizing disposable, non-durable medical equipment including provision of exudate management collection system, topical application(s), wound assessment, and instructions for ongoing care, per session; total wound(s) surface area less than or equal to 50 square centimeters.

Status indicator: T

APC group: 5052

Total Medicare APC Allowable Payment Rate: $380.32

CPT^® Code: 97608

Status indicator: T

APC group: 5052

Total Medicare APC Allowable Payment Rate: $380.32

Please be sure to check with your patient’s individual health insurance provider to ensure coverage, coding, and payment requirements are met for the site of care and provider.

See the 2024 Medicare Hospital Outpatient OPPS Fee Schedule:

The Centers for Medicare and Medicaid Services. Hospital Outpatient PPS - Addendum A and Addendum B Updates. Retrieved from: https://www.cms.gov/medicare/payment/prospective-payment-systems/hospital-outpatient/regulations-notices/cms-1786-fc (11.2023)

*The national average 2024 Medicare rates for the hospital outpatient setting are calculated from the 2021 Hospital Outpatient Prospective Payment System (OPPS). The Medicare payment amounts listed do not reflect adjustments for deductibles, copayments, coinsurance, sequestration or any other reductions. All payment amounts listed are based on national averages. Medicare payment amounts will vary by geographical locations.

References:

Hospital-based Outpatient Wound Care Departments (HOPDs)

Hospital-based Outpatient Wound Care Departments (HOPDs)

The American Medical Association has established two CPT codes for Single Use Negative Pressure Wound Therapy (sNPWT): 97607 and 97608

The American Medical Association has established two CPT codes for Single Use Negative Pressure Wound Therapy (sNPWT): 97607 and 97608

CPT^® Code: 97607

CPT^® Code: 97608

See the 2024 Medicare Hospital Outpatient OPPS Fee Schedule:

Want to get started with PICO?

Are you a patient with questions?

Billing questions?

Hospital-based Outpatient Wound Care Departments (HOPDs)

Hospital-based Outpatient Wound Care Departments (HOPDs)

The American Medical Association has established two CPT codes for Single Use Negative Pressure Wound Therapy (sNPWT): 97607 and 97608

The American Medical Association has established two CPT codes for Single Use Negative Pressure Wound Therapy (sNPWT): 97607 and 97608

CPT® Code: 97607

CPT® Code: 97608

See the 2024 Medicare Hospital Outpatient OPPS Fee Schedule:

Want to get started with PICO?

Are you a patient with questions?

Billing questions?

CPT^® Code: 97607

CPT^® Code: 97608