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: 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: A
Medicare Allowable Non-Facility Rate: $347.85
Medicare Allowable Facility Rate: $20.97
CPT® Code: 97608
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 greater than 50 square centimeters.
Status indicator: A
Medicare Allowable Non-Facility Rate: $359.84
Medicare Allowable Facility Rate: $24.63
Medicare has assigned CPT codes 97607 and 97608 (single-use negative pressure wound therapy) with a status code of “A” meaning these codes are paid separately under the physician fee schedule, if covered. There will be RVUs for codes with this status. The presence of an “A” indicator does not mean that Medicare has made a national coverage determination regarding the service; carriers remain responsible for coverage decisions in the absence of a national Medicare policy.
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.
