{"id":3818,"date":"2025-06-17T16:48:43","date_gmt":"2025-06-17T16:48:43","guid":{"rendered":"https:\/\/medibillmd.com\/blog\/?p=3818"},"modified":"2025-06-17T16:48:44","modified_gmt":"2025-06-17T16:48:44","slug":"cpt-code-97605","status":"publish","type":"post","link":"https:\/\/medibillmd.com\/blog\/cpt-code-97605\/","title":{"rendered":"Ultimate Guide to CPT Code 97605"},"content":{"rendered":"\n<p>Do you know when to use different codes for negative pressure wound therapy (NPWT)? The choice depends on the size of the wound! Healthcare providers use this therapy to treat several injuries, including chronic wounds, which affect around <a href=\"https:\/\/www.aahcm.org\/index.php?option=com_dailyplanetblog&amp;tag=-chronic-wounds\" target=\"_blank\" rel=\"noreferrer noopener nofollow\">6.5 million Americans each year<\/a>.<\/p>\n\n\n\n<p>However, they often get confused between different NPWT codes and struggle to get paid for this service. And you know how a lack of proper coding knowledge can lead to more mistakes and frustration.&nbsp;<\/p>\n\n\n\n<p>CPT code 97605 is a popular code for wound care. Let us explain everything about this code so you can use it correctly.<\/p>\n\n\n\t\t\t\t<div class=\"wp-block-uagb-table-of-contents uagb-toc__align-left uagb-toc__columns-1 uagb-toc__collapse uagb-block-b40279f1      \"\n\t\t\t\t\tdata-scroll= \"1\"\n\t\t\t\t\tdata-offset= \"30\"\n\t\t\t\t\tstyle=\"\"\n\t\t\t\t>\n\t\t\t\t<div class=\"uagb-toc__wrap\">\n\t\t\t\t\t\t<div class=\"uagb-toc__title\">\n\t\t\t\t\t\t\tTable Of Contents\t\t\t\t\t\t\t\t\t\t\t\t\t<svg xmlns=\"https:\/\/www.w3.org\/2000\/svg\" viewBox= \"0 0 384 512\"><path d=\"M192 384c-8.188 0-16.38-3.125-22.62-9.375l-160-160c-12.5-12.5-12.5-32.75 0-45.25s32.75-12.5 45.25 0L192 306.8l137.4-137.4c12.5-12.5 32.75-12.5 45.25 0s12.5 32.75 0 45.25l-160 160C208.4 380.9 200.2 384 192 384z\"><\/path><\/svg>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"uagb-toc__list-wrap \">\n\t\t\t\t\t\t<ol class=\"uagb-toc__list\"><li class=\"uagb-toc__list\"><a href=\"#cpt-code-97605-description\" class=\"uagb-toc-link__trigger\">CPT Code 97605 &#8211; Description<\/a><li class=\"uagb-toc__list\"><a href=\"#scenarios-where-cpt-code-97605-is-applicable\" class=\"uagb-toc-link__trigger\">Scenarios Where CPT Code 97605 is Applicable<\/a><ul class=\"uagb-toc__list\"><li class=\"uagb-toc__list\"><a href=\"#npwt-to-treat-foot-ulcer\" class=\"uagb-toc-link__trigger\">NPWT to Treat Foot Ulcer<\/a><li class=\"uagb-toc__list\"><li class=\"uagb-toc__list\"><a href=\"#npwt-to-manage-traumatic-hand-laceration\" class=\"uagb-toc-link__trigger\">NPWT to Manage Traumatic Hand Laceration<\/a><li class=\"uagb-toc__list\"><li class=\"uagb-toc__list\"><a href=\"#npwt-to-manage-traumatic-pressure-ulcer\" class=\"uagb-toc-link__trigger\">NPWT to Manage Traumatic Pressure Ulcer<\/a><\/li><\/ul><\/li><li class=\"uagb-toc__list\"><a href=\"#applicable-modifiers-for-cpt-code-97605\" class=\"uagb-toc-link__trigger\">Applicable Modifiers for CPT Code 97605<\/a><ul class=\"uagb-toc__list\"><li class=\"uagb-toc__list\"><a href=\"#modifier-53\" class=\"uagb-toc-link__trigger\">Modifier 53<\/a><li class=\"uagb-toc__list\"><li class=\"uagb-toc__list\"><a href=\"#modifier-59\" class=\"uagb-toc-link__trigger\">Modifier 59<\/a><li class=\"uagb-toc__list\"><li class=\"uagb-toc__list\"><a href=\"#modifier-xs\" class=\"uagb-toc-link__trigger\">Modifier XS<\/a><li class=\"uagb-toc__list\"><li class=\"uagb-toc__list\"><a href=\"#modifier-79\" class=\"uagb-toc-link__trigger\">Modifier 79<\/a><\/li><\/ul><\/li><\/ul><\/li><li class=\"uagb-toc__list\"><a href=\"#cpt-code-97605-billing-reimbursement-guidelines\" class=\"uagb-toc-link__trigger\">CPT Code 97605 &#8211; Billing &amp; Reimbursement Guidelines<\/a><ul class=\"uagb-toc__list\"><li class=\"uagb-toc__list\"><a href=\"#use-code-97605-correctly-only-for-npwt-using-dme\" class=\"uagb-toc-link__trigger\">Use Code 97605 Correctly (Only for NPWT Using DME)<\/a><li class=\"uagb-toc__list\"><li class=\"uagb-toc__list\"><a href=\"#use-code-97605-for-managing-50-cm-wounds\" class=\"uagb-toc-link__trigger\">Use Code 97605 for Managing \u2264 50 cm\u00b2 Wounds<\/a><li class=\"uagb-toc__list\"><li class=\"uagb-toc__list\"><a href=\"#document-npwt-thoroughly\" class=\"uagb-toc-link__trigger\">Document NPWT Thoroughly<\/a><li class=\"uagb-toc__list\"><li class=\"uagb-toc__list\"><a href=\"#apply-appropriate-modifiers\" class=\"uagb-toc-link__trigger\">Apply Appropriate Modifiers<\/a><li class=\"uagb-toc__list\"><li class=\"uagb-toc__list\"><a href=\"#comply-with-payer-specific-rules\" class=\"uagb-toc-link__trigger\">Comply with Payer-Specific Rules<\/a><\/li><\/ul><\/li><\/ul><\/li><\/ul><\/li><li class=\"uagb-toc__list\"><a href=\"#summary\" class=\"uagb-toc-link__trigger\">Summary<\/a><\/ul><\/ul><\/ul><\/ol>\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\n\n\n<div style=\"height:30px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>CPT Code 97605<\/strong><strong> &#8211; Description<\/strong><\/h2>\n\n\n\n<p>So, what does CPT code 97605 specifically refer to? Categorized as an active wound management code, CPT code 97605 specifies <strong>negative pressure wound therapy (NPWT)<\/strong>, also commonly known as vacuum-assisted closure therapy.&nbsp;<\/p>\n\n\n\n<p>As we said earlier, there are several codes for NPWT. So, you might be wondering which wound size and device qualify for this code. Healthcare providers use CPT code 97605 to treat small ulcers, surgical wounds, or traumatic injuries with a <strong>total surface area of 50 cm\u00b2 or less<\/strong>.&nbsp;<\/p>\n\n\n\n<p>During this procedure, a healthcare provider removes fluid or debris from the wound to promote healing. He does that by applying a sealed dressing over the lesion. This dressing is connected to a vacuum-like <strong>durable medical equipment<\/strong> (DME) that creates a subatmospheric (negative) pressure, gently pulling fluids or infectious material.&nbsp;<\/p>\n\n\n\n<p>NPWT is useful for treating complex wounds, especially those that heal slowly. The primary goals of this procedure? To reduce wound size and decrease infection risk while promoting tissue regeneration.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>Scenarios Where <\/strong><strong>CPT Code 97605<\/strong><strong> is Applicable<\/strong><\/h2>\n\n\n\n<p>Want to apply CPT code 97605 correctly? Read the following scenarios:<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>NPWT to Treat Foot Ulcer<\/strong><\/h3>\n\n\n\n<p>Did you know diabetic patients are at a higher risk of developing foot ulcers (open sores or wounds)? In fact, around <a href=\"https:\/\/jamanetwork.com\/journals\/jama\/fullarticle\/2812203\" target=\"_blank\" rel=\"noreferrer noopener nofollow\">1.6 million people<\/a> in the U.S. suffer from diabetic foot ulcers. Negative pressure wound therapy can help prevent these sores from becoming infected.<\/p>\n\n\n\n<p>Let\u2019s consider this for our first scenario! Suppose a 56-year-old man with type 2 diabetes develops a neurotrophic ulcer on the sole of his left foot. The wound does not respond to standard treatment and is slow to heal. He visits the nearest reliable doctor for consultation.&nbsp;<\/p>\n\n\n\n<p>After examining the ulcer, the provider orders several tests to determine the depth of the wound and identify signs of infection. After confirming the total surface area (30 cm<sup>2<\/sup>), the doctor performs negative pressure wound therapy to drain the wound and promote healing.&nbsp;<\/p>\n\n\n\n<p>Since the wound area is less than 50 cm<sup>2<\/sup>, the provider uses CPT code 97605 to bill for the procedure.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>NPWT to Manage Traumatic Hand Laceration<\/strong><\/h3>\n\n\n\n<p>Lacerations are quite common, with up to <a href=\"https:\/\/www.meturgentcare.com\/blog\/preventing-wound-infections-steps-for-effective-laceration-care\" target=\"_blank\" rel=\"noreferrer noopener nofollow\">15% of untreated cases<\/a> becoming complicated. Even simple hand wounds are at a greater risk. Specifically, <a href=\"https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC4369530\/\" target=\"_blank\" rel=\"noreferrer noopener nofollow\">5% of hand lacerations<\/a> become infected. That\u2019s why healthcare providers often perform negative pressure wound therapy to promote healing.<\/p>\n\n\n\n<p>So, for the next scenario, envision a 32-year-old woman with a traumatic hand injury. Let\u2019s suppose she sustains a deep laceration (20 cm\u00b2) on her right hand after falling onto broken glass from a ladder. Although the wound initially closes after treatment, it later becomes swollen.<\/p>\n\n\n\n<p>To reduce the risk of infection, the doctor cleans and dries the wound, then applies subatmospheric (negative) pressure to remove excess fluid. Given the wound\u2019s total surface area, he uses CPT code 97605 to report the procedure.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>NPWT to Manage Traumatic Pressure Ulcer<\/strong><\/h3>\n\n\n\n<p>Did you know that every year, more than<a href=\"https:\/\/www.ahrq.gov\/topics\/pressure-ulcers.html\" target=\"_blank\" rel=\"noreferrer noopener nofollow\"> 2.5 million people in the U.S.<\/a> develop pressure ulcers (bedsores)? Therefore, let&#8217;s use this as an example. Consider a 75-year-old woman who is bedridden after breaking her hipbone. Due to limited mobility and poor circulation, she develops a painful and itchy bedsore on her back.\u00a0<\/p>\n\n\n\n<p>Despite keeping it covered with a dressing, healing is slow. Hence, the patient&#8217;s family consults a physician. After evaluating the size (30 cm\u00b2) and stage (II) of the pressure wound, the healthcare provider removes excessive fluid and bacteria via suction to improve the blood flow.&nbsp;&nbsp;<\/p>\n\n\n\n<p>Since her bedsore is less than 50 cm\u00b2, the billing team uses CPT code 97605 to file a claim for the performed procedure.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>Applicable Modifiers for <\/strong><strong>CPT Code 97605<\/strong><\/h2>\n\n\n\n<p>You can use the following modifiers with CPT code 97605 to correctly bill for negative pressure wound therapy:<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Modifier 53<\/strong><\/h3>\n\n\n\n<p>Did you discontinue negative pressure wound therapy due to some complication, such as bleeding, rupture, or pain? You can append <a href=\"https:\/\/medibillmd.com\/blog\/modifier-53\/\" target=\"_blank\" data-type=\"link\" data-id=\"https:\/\/medibillmd.com\/blog\/modifier-53\/\" rel=\"noreferrer noopener\">modifier 53<\/a> to CPT code 97605, especially if you abandoned the treatment after administering anesthesia.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Modifier 59<\/strong><\/h3>\n\n\n\n<p>Was NPWT distinct from another service or procedure you performed on the same day on the same patient? Use <a href=\"https:\/\/medibillmd.com\/blog\/modifier-51-vs-59\/\" target=\"_blank\" data-type=\"link\" data-id=\"https:\/\/medibillmd.com\/blog\/modifier-51-vs-59\/\" rel=\"noreferrer noopener\">modifier 59<\/a> with CPT code 97605 to communicate this information.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Modifier XS<\/strong><\/h3>\n\n\n\n<p>It is always better to use one of the more specific X{EPSU} modifiers instead of modifier 59 to avoid scrutiny. So, if negative pressure wound therapy was distinct from another service because you performed it on a separate structure, apply <a href=\"https:\/\/medibillmd.com\/blog\/xs-modifier\/\" data-type=\"link\" data-id=\"https:\/\/medibillmd.com\/blog\/xs-modifier\/\">modifier XS<\/a> to CPT code 97605.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Modifier 79<\/strong><\/h3>\n\n\n\n<p>Did you perform NPWT during the post-operative period of an unrelated surgery? For example, if you removed excessive fluid from a diabetic ulcer during a patient\u2019s post-operative knee surgery period, you can use <a href=\"https:\/\/medibillmd.com\/blog\/modifier-79\/\" target=\"_blank\" data-type=\"link\" data-id=\"https:\/\/medibillmd.com\/blog\/modifier-79\/\" rel=\"noreferrer noopener\">modifier 79<\/a> with CPT code 97605.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>CPT Code 97605<\/strong><strong> &#8211; Billing &amp; Reimbursement Guidelines<\/strong><\/h2>\n\n\n\n<p>For timely and complete reimbursements, you should understand the billing requirements associated with each code. Want to avoid denials for negative pressure wound therapy? Follow these instructions to file accurate claims for CPT code 97605:<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Use Code 97605 Correctly (Only for NPWT Using DME)<\/strong><\/h3>\n\n\n\n<p>Due to the close similarity between CPT codes 97605 and 97607, many healthcare providers often use these codes inaccurately. To clarify, 97605 covers the removal of fluids or infectious material via durable medical equipment (DME).&nbsp;<\/p>\n\n\n\n<p>If you have used disposable, non-durable equipment for performing negative pressure wound therapy, use CPT code 97607 instead of 97605.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Use Code 97605 for Managing \u2264 50 cm\u00b2 Wounds<\/strong><\/h3>\n\n\n\n<p>Wound surface area is also important. CPT code 97605 only applies when you perform NPWT on an ulcer, laceration, or traumatic injury that is less than or equal to 50 cm<sup>2<\/sup>.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Document NPWT Thoroughly<\/strong><\/h3>\n\n\n\n<p>Without a strong medical justification, insurance payers will deny your claims. Therefore, maintain complete documentation for negative pressure wound therapy while filing a claim for CPT code 97605. Make sure to record the following details:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Wound details (size, condition, location)<\/li>\n\n\n\n<li>Appropriate ICD-10 codes that support NPWT<\/li>\n\n\n\n<li>Type of equipment used (DME, in this case)<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Apply Appropriate Modifiers<\/strong><\/h3>\n\n\n\n<p>When applicable, use appropriate modifiers with CPT code 97605 to convey additional information. We have mentioned several appropriate modifiers in the section above.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Comply with Payer-Specific Rules<\/strong><\/h3>\n\n\n\n<p>We all know that payers have varying policies, some require pre-authorizations, while others ask for specific documentation. In this case, insurers may limit their NPWT coverage to specific DME brands. Therefore, verify each insurance provider\u2019s billing requirements for CPT code 97605 to avoid denials.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>Summary<\/strong><\/h2>\n\n\n\n<p>Ready to file a claim for negative pressure wound therapy? CPT code 97605 is often misused due to coding confusion. That\u2019s why we discussed it in so much detail, including what it covers (wound size and equipment type) and how you can use it accurately.&nbsp;<\/p>\n\n\n\n<p>To summarize, CPT 97605 refers to negative pressure wound therapy, which involves applying a vacuum to a wound (50 cm<sup>2<\/sup> or smaller) using specialized DME. Insurance companies pay for this service only if you follow their specific guidelines and submit proper documentation.&nbsp;<\/p>\n\n\n\n<p>Therefore, we highlighted the appropriate modifiers and billing rules to help you avoid denials. But if you cannot spare extra hours on billing, consider partnering with a reliable company. Many top <a href=\"https:\/\/medibillmd.com\/specialties\/wound-care-billing-services\" target=\"_blank\" rel=\"noreferrer noopener\"><strong>wound care billing services<\/strong><\/a> providers, including MediBillMD, can help you receive timely reimbursements.<\/p>\n\n\n\n<p><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Do you know when to use different codes for negative pressure wound therapy (NPWT)? The choice depends on the size [&hellip;]<\/p>\n","protected":false},"author":3,"featured_media":3820,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_eb_attr":"","content-type":"","_uag_custom_page_level_css":"","site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"categories":[10],"tags":[],"class_list":["post-3818","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-cpt-codes"],"uagb_featured_image_src":{"full":["https:\/\/medibillmd.com\/blog\/wp-content\/uploads\/2025\/06\/CPT-Code-97605.webp",1200,720,false],"thumbnail":["https:\/\/medibillmd.com\/blog\/wp-content\/uploads\/2025\/06\/CPT-Code-97605-150x150.webp",150,150,true],"medium":["https:\/\/medibillmd.com\/blog\/wp-content\/uploads\/2025\/06\/CPT-Code-97605-300x180.webp",300,180,true],"medium_large":["https:\/\/medibillmd.com\/blog\/wp-content\/uploads\/2025\/06\/CPT-Code-97605-768x461.webp",768,461,true],"large":["https:\/\/medibillmd.com\/blog\/wp-content\/uploads\/2025\/06\/CPT-Code-97605-1024x614.webp",1024,614,true],"1536x1536":["https:\/\/medibillmd.com\/blog\/wp-content\/uploads\/2025\/06\/CPT-Code-97605.webp",1200,720,false],"2048x2048":["https:\/\/medibillmd.com\/blog\/wp-content\/uploads\/2025\/06\/CPT-Code-97605.webp",1200,720,false]},"uagb_author_info":{"display_name":"Fred Allen","author_link":"https:\/\/medibillmd.com\/blog\/author\/fred-allen\/"},"uagb_comment_info":0,"uagb_excerpt":"Do you know when to use different codes for negative pressure wound therapy (NPWT)? The choice depends on the size [&hellip;]","_links":{"self":[{"href":"https:\/\/medibillmd.com\/blog\/wp-json\/wp\/v2\/posts\/3818","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/medibillmd.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medibillmd.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/medibillmd.com\/blog\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/medibillmd.com\/blog\/wp-json\/wp\/v2\/comments?post=3818"}],"version-history":[{"count":0,"href":"https:\/\/medibillmd.com\/blog\/wp-json\/wp\/v2\/posts\/3818\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/medibillmd.com\/blog\/wp-json\/wp\/v2\/media\/3820"}],"wp:attachment":[{"href":"https:\/\/medibillmd.com\/blog\/wp-json\/wp\/v2\/media?parent=3818"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medibillmd.com\/blog\/wp-json\/wp\/v2\/categories?post=3818"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medibillmd.com\/blog\/wp-json\/wp\/v2\/tags?post=3818"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}