Billing code 97605: Wound therapyMedicare rate & RVUs
Reports a DME-based negative-pressure wound therapy session for one or more wounds whose combined treated surface area is 50 square centimeters or less.
Medicare pays $42.09 for 97605 nationally in the office and $21.04 in a hospital or facility. Local office rates run $38.58–$54.40.
Medicare rate · 97605
Wound therapy
Swap in your local Medicare rate.
- Work RVUs
- 0.54
- Total RVUs
- 1.26
- Global days
- XXX
National rate · 2026
$42.09
Office setting, before claim adjustments.
See every locality for 97605 → · Billed by an NP, PA or therapist? →
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 10 sections
What 97605 covers
Code 97605 represents a session of negative-pressure wound therapy delivered with equipment that qualifies as durable medical equipment, when the combined surface area of treated wounds is 50 square centimeters or less. A sealed dressing connected to suction helps manage an open wound by drawing away fluid. Surgeons and wound-care clinicians commonly oversee this treatment in outpatient wound clinics and postoperative care. Dressing application, wound assessment, and patient or caregiver instruction for ongoing care are included.
Select the area tier using the combined surface area of wounds treated in the session, not the number of wounds; 97606 is used when the total exceeds 50 square centimeters. The equipment pathway also matters: use 97607 or 97608 for systems that do not require DME, applying the same area threshold. Document the treated wounds and their dimensions, equipment used, therapy provided, assessment, and instruction. CMS assigns work, practice-expense, and malpractice RVUs, with separate office and facility practice-expense inputs in the fee schedule.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
Where 97605 pays more and less
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
109 payment localities
$38.58 to $54.40
109 of 109 payment localities
97605 rates by state
Office rate range in each state. Select a state to see its payment localities.
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Local rates. Clear comparisons.
Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.
$38.58
$52.49
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $52.49 | 1 |
| AL | $38.98 | 1 |
| AR | $38.58 | 1 |
| AZ | $41.30 | 1 |
| CA | $44.51–$54.40 | 29 |
| CO | $43.75 | 1 |
| CT | $44.34 | 1 |
| DC | $47.32 | 1 |
| DE | $41.86 | 1 |
| FL | $41.21–$43.57 | 3 |
| GA | $39.59–$42.59 | 2 |
| GU | $45.19 | 1 |
| HI | $45.19 | 1 |
| IA | $39.87 | 1 |
| ID | $40.01 | 1 |
| IL | $40.21–$43.11 | 4 |
| IN | $40.18 | 1 |
| KS | $39.64 | 1 |
| KY | $39.42 | 1 |
| LA | $39.34–$40.73 | 2 |
| MA | $43.56–$47.39 | 2 |
| MD | $42.52–$47.32 | 3 |
| ME | $40.06–$41.75 | 2 |
| MI | $40.07–$41.48 | 2 |
| MN | $42.54 | 1 |
| MO | $38.80–$40.95 | 3 |
| MS | $38.70 | 1 |
| MT | $42.08 | 1 |
| NC | $40.38 | 1 |
| ND | $41.89 | 1 |
| NE | $40.05 | 1 |
| NH | $43.02 | 1 |
| NJ | $45.02–$47.04 | 2 |
| NM | $40.18 | 1 |
| NV | $42.05 | 1 |
| NY | $40.80–$48.01 | 5 |
| OH | $40.02 | 1 |
| OK | $39.47 | 1 |
| OR | $41.89–$44.92 | 2 |
| PA | $40.12–$43.45 | 2 |
| PR | $42.34 | 1 |
| RI | $43.17 | 1 |
| SC | $40.23 | 1 |
| SD | $41.86 | 1 |
| TN | $39.77 | 1 |
| TX | $39.93–$43.46 | 8 |
| UT | $40.63 | 1 |
| VA | $41.58–$47.32 | 2 |
| VI | $42.34 | 1 |
| VT | $41.68 | 1 |
| WA | $43.50–$48.31 | 2 |
| WI | $40.86 | 1 |
| WV | $39.12 | 1 |
| WY | $42.00 | 1 |
How the 97605 rate is calculated
Each of 97605’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 97605
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 0.54Practice expense 0.71Malpractice 0.01
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 97605
97605 has no global surgery period, no multiple-procedure, bilateral or assistant-at-surgery adjustment, and no professional/technical split. What changes the payment is where the service happens: the place of service on the claim decides whether Medicare pays the office or the facility rate.
Place of service · 97605
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
Non-facility (office) rate · national
$42.09
The facility rate would be $21.04 (+$21.05). In a facility, the facility bills its own costs separately.
97605 compared with similar codes
Compare codes
97605 vs 97606 vs 97607 vs 97602: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 97606Negative pressure therapy
- Both codes describe DME-based negative-pressure wound therapy. Choose 97605 for a combined treated wound area of 50 square centimeters or less and 97606 for an area above that threshold.
- 97607Negative pressure therapy
- Both cover negative-pressure therapy for a combined wound area of 50 square centimeters or less. The distinction is whether the equipment requires DME.
- 97602Wound(s) care non-selective
- 97602 is for non-selective wound care, not negative-pressure therapy. Use 97605 when suction-based wound treatment with DME is provided.
97605 billing questions
How is the wound-area threshold determined?
Use the combined surface area of the wounds treated during the session. This code is for a total of 50 square centimeters or less; 97606 is for a larger total.
When should 97607 be used instead?
Use 97607 when the negative-pressure system does not require DME and the combined treated wound area is 50 square centimeters or less. The corresponding higher-area code is 97608.
Can the dressing application or wound assessment be billed separately?
Dressing application, wound assessment, and instruction for ongoing care are included in this service. Do not report those included elements as separate wound-care services.
Is the code reported once for each wound?
The area threshold is based on the combined wounds treated in the session, not a separate threshold for each wound. Document the individual wounds and their dimensions to support the total.
How does this differ from 97602?
97605 describes negative-pressure therapy using DME. Code 97602 describes non-selective wound care, such as routine cleansing or dressing care, rather than this suction-based treatment.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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