CPT 97605: Negative Pressure Wound Therapy for Small Wounds
Medicare pays $44 and commercial payers pay $104 on average nationally for this procedure.
CPT code 97605 describes negative pressure wound therapy using durable medical equipment to apply controlled subatmospheric pressure via a sealed dressing for removal of fluids and infectious material and to promote healing for wounds with a total surface area less than or equal to 50 square centimeters; service type: negative pressure wound therapy (NPWT); typical site of service: outpatient clinic, physician office, wound care center, or other ambulatory care settings.
For related coverage guidance, see recent payer policy updates: Home Health, Skilled, and Custodial Care Services (for Idaho Only), Private Duty Nursing Services (for Florida Only), Private Duty Nursing Services.
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National Reimbursement Benchmarks
Nationally, Medicare’s mean rate of $43.7 for CPT 97605 sits below the BUCA commercial average of $104.4, with BUCA roughly 2.4 times higher than Medicare on average. This spread highlights a substantial gap between government reimbursement and a representative commercial aggregator, reflecting common divergence between public fee schedules and commercial market pricing.
Rate dispersion measured by the interquartile range (P75–P25) is narrowest for Aetna at $23.6 and tight for UnitedHealth Group at $15.0 and Cigna at $39.6, indicating more clustered commercial contracting for Aetna and UnitedHealth Group. Blue Cross Blue Shield shows the widest IQR at $57.6, signaling greater variability among BCBS arrangements; BUCA’s IQR is $43.7 and Medicare’s IQR is $4.0, with Medicare being the most consistent by this measure.