$48.93
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.
On this page
CMS RVU26D · Effective 2026-10-01
97605 Wound therapy Medicare reimbursement rates in Wisconsin
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. Compare 97605 office and facility rates across CMS payment localities in Wisconsin.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 97605 in Wisconsin?
Wisconsin has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
$40.86
1 of 1 localities have a supported rate.
Payment area: Wisconsin
One mapped payment locality.
Facility setting
$20.70
1 of 1 localities have a supported rate.
Payment area: Wisconsin
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Wound care
About 97605: Low-area DME negative-pressure wound therapy
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.
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.
Where the value comes from
- Work RVU0.54 · 43%
- Practice expense (office) RVU0.71 · 56%
- Malpractice RVU0.01 · 1%
38.7K
Medicare services in 2024 · #884 by national volume
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.
97605 compared with similar codes
Office rates for Wisconsin, from the same CMS release.
$351.24
Both cover negative-pressure therapy for a combined wound area of 50 square centimeters or less. The distinction is whether the equipment requires DME.
97602
No office rateWound(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.
Compare 97605 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Wisconsin →
Office / nonfacility
$40.86
Facility
$20.70
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 97605 in Wisconsin.
PPRRVU2026_Oct_nonQPP.csv
12,902
- Code
- 97605
- Physician work
- 0.54
- Practice expense
- 0.71
- Malpractice
- 0.01
GPCI2026.csv
111
- Locality
- Wisconsin
- Physician work
- 1.000
- Practice expense
- 0.958
- Malpractice
- 0.308
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.54 | × 1.000 | 0.5400 |
| Practice expense | 0.71 | × 0.958 | 0.6802 |
| Malpractice | 0.01 | × 0.308 | 0.0031 |
| Total RVUs | 1.2233 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Wisconsin$40.86
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0.54 | 1 |
| Practice expense | 0.71 | 0.958 |
| Malpractice | 0.01 | 0.308 |
(0.54 × 1 + 0.71 × 0.958 + 0.01 × 0.308) × $33.4009 = $40.86
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0.54 | 1 |
| Practice expense | 0.08 | 0.958 |
| Malpractice | 0.01 | 0.308 |
(0.54 × 1 + 0.08 × 0.958 + 0.01 × 0.308) × $33.4009 = $20.70
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
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 indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
12,89997597,,Dbrdmt opn wnd 1st 20 cm/<,A,,0.75,2.24,,0.13,,0.05,3.04,0.93,0,000,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,90097598,,Dbrdmt opn wnd addl 20cm/<,A,,0.49,0.88,,0.10,,0.06,1.43,0.65,0,ZZZ,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,90197602,,Wound(s) care non-selective,B,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
12,90297605,,Neg prs wnd ther dme<=50sqcm,A,,0.54,0.71,,0.08,,0.01,1.26,0.63,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,90397606,,Neg prs wnd ther dme>50 sqcm,A,,0.59,0.91,,0.09,,0.01,1.51,0.69,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,90497607,,Neg prs wnd thr ndme<=50sqcm,A,,0.40,10.54,,0.10,,0.06,11.00,0.56,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,90597608,,Neg prs wnd ther ndme>50sqcm,A,,0.45,11.35,,0.12,,0.08,11.88,0.65,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
10802402,WA,02,SEATTLE (KING CNTY),1.050,1.227,0.817
10902402,WA,99,REST OF WASHINGTON,1.013,1.053,0.761
11011402,WV,16,WEST VIRGINIA,1.000,0.869,1.431
11106302,WI,00,WISCONSIN,1.000,0.958,0.308
11203602,WY,21,WYOMING**,1.000,1.000,0.740
113"MAC Assignments as of November 22, 2023",,,,,,
114,,,,,,