The Application Codes
CPT separates NPWT by device type and wound size.
- 97605: NPWT using durable medical equipment, total wound surface area 50 sq cm or less
- 97606: NPWT using durable medical equipment, total wound surface area greater than 50 sq cm
- 97607: NPWT using a disposable, non-durable device, 50 sq cm or less
- 97608: NPWT using a disposable, non-durable device, greater than 50 sq cm
Pumps And Supplies Under The DME Benefit
A home NPWT pump and its dressings and canisters are covered under the durable medical equipment benefit and billed by the DME supplier to the DME MAC. Coverage follows the DME MAC policy for negative pressure wound therapy pumps (LCD L33821), which requires a qualifying wound type and documentation that a complete wound therapy program was tried or considered first.
Documentation For Continued Coverage
NPWT coverage is not open-ended. The treating clinician needs to evaluate the wound regularly and record measurements, and coverage ends when the wound stops showing measurable improvement.
- Wound type, stage or depth, and measurements at initiation
- Prior wound therapy and why NPWT is now needed
- Regular measurements showing response to therapy
- Supervision of dressing changes and the plan for discontinuation
Common Errors
- Billing 97605 or 97606 when a disposable device was used, or the reverse
- Wound area missing, so the code cannot be supported
- Measurements not updated, so continued use looks unsupported
- Physician order and wound evaluation not available to the DME supplier
Frequently Asked Questions
- Is the disposable NPWT device billed separately?
- For Medicare, codes 97607 and 97608 include the disposable device. The supplies are not billed on a separate line by the practice.
- Who bills the pump rental?
- The DME supplier bills the pump and supplies to the DME MAC. The practice supplies the order and the clinical documentation that supports coverage.
Billing Support For This Specialty
Physicians Professional Billing Services, Inc. has billed wound care, surgical and procedural specialties since 1998, across every Medicare Part B MAC jurisdiction.
Primary Sources
This page is general information about billing and coverage rules and is not legal, coding or reimbursement advice for a specific claim. Coverage policies change; confirm current requirements with CMS and the applicable Medicare Administrative Contractor.