Billing code 97606: Negative pressure therapyMedicare rate & RVUs in Illinois
Reports a session of negative pressure wound therapy using durable medical equipment when the combined treated wound surface area exceeds 50 square centimeters.
Medicare pays $47.98–$51.65 for 97606 in the office in Illinois, from Rest Of Illinois to Suburban Chicago. Which amount applies depends on the service address.
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 9 sections
What 97606 covers
This service covers a session managing negative pressure wound therapy delivered with durable medical equipment, such as a pump-based vacuum system. The treating clinician assesses the wound, applies or manages the therapy dressings, and provides care instructions as part of the session. It is used for wounds requiring negative pressure treatment in settings such as a physician office or hospital outpatient department.
Select this code when the total surface area of the wound or wounds treated during the session is greater than 50 square centimeters and the equipment is durable medical equipment. Document the wound locations and measurements, the combined area, use of the DME system, and the work performed during the session. The code is reported per session, rather than per wound or dressing. CMS assigns work, practice expense, and malpractice RVUs; the practice expense RVU differs between office and facility settings.
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 97606 pays more and less in Illinois
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
4 payment localities
$47.98 to $51.65
| Payment locality | Office | Facility |
|---|---|---|
| Chicago | $51.16 | $23.63 |
| East St. Louis | $48.34 | $23.14 |
| Rest Of Illinois | $47.98 | $22.97 |
| Suburban Chicago | $51.65 | $23.52 |
How the 97606 rate is calculated
Each of 97606’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 · 97606
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 0.59Practice expense 0.91Malpractice 0.01
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 97606
97606 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 · 97606
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
Non-facility (office) rate · national
$50.44
The facility rate would be $23.05 (+$27.39). In a facility, the facility bills its own costs separately.
97606 compared with similar codes
Compare codes
97606 vs 97605 vs 97608 vs 97607: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 97605Wound therapy
- Both codes involve DME-based negative pressure wound therapy. Choose 97606 for a total treated area greater than 50 square centimeters and 97605 for 50 square centimeters or less.
- 97608Negative pressure therapy
- Both use the greater-than-50-square-centimeter wound-area threshold. The distinction is the equipment: 97606 is for DME, while 97608 is for a disposable non-DME system.
- 97607Negative pressure therapy
- 97607 describes disposable non-DME negative pressure therapy for 50 square centimeters or less; 97606 requires DME and an area greater than 50 square centimeters.
97606 billing questions
How is this code distinguished from 97605?
Both describe DME-based negative pressure wound therapy. Use 97606 when the combined treated wound surface area is greater than 50 square centimeters; 97605 is for 50 square centimeters or less.
Does the wound area refer to each wound or all wounds treated?
Use the combined surface area of the wound or wounds treated during the session. Document the individual measurements and the total used to select the code.
When is 97608 used instead?
97608 describes negative pressure wound therapy for a total wound area greater than 50 square centimeters using a disposable, non-DME system. This code is for DME.
Is the code reported per wound or per session?
It is reported per session. The code selection reflects the total area treated in that session, not the number of wounds or dressings.
What documentation supports reporting this code?
Record wound locations and measurements, the combined treated area, use of a DME negative pressure system, and the therapy management performed during the session.
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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