Find policies, billing codes, payers, states, and providers
CPT 97605: Negative Pressure Wound Therapy for Small Wounds
CPT code 97605 represents negative pressure wound therapy (NPWT) delivered with durable medical equipment for wounds with a total surface area of 50 square centimeters or less. This service controls subatmospheric pressure through a sealed dressing to remove exudate and infectious material and to promote wound healing. The code is commonly used in ambulatory and outpatient wound care settings and is an important tool in managing chronic and complex wounds nationally.
Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, United Healthcare, and Medicare. Readers will find an overview of payer coverage considerations and comparative benchmarks for utilization and reimbursement practices, a summary of clinical indications and typical sites of service, and guidance on associated service coding such as related NPWT codes. The publication also clarifies how 97605 differs from the related CPT code 97606, which is used for total wound surface areas greater than 50 square centimeters.
This summary provides clinicians, billing managers, and policy analysts with concise context on where 97605 fits within wound care coding, expected clinical application, and the payer landscape nationally. Data not available in the input is noted where applicable.
Customize your policy alerts
Sign up for cpt 97605 policy alerts
Get alerted when payer policies referencing 97605 are released or updated.
Monitor payer policy activity
Billing Code Overview
CPT code 97605 describes negative pressure wound therapy (NPWT) using durable medical equipment for wounds with total surface area less than or equal to 50 square centimeters. The provider applies controlled subatmospheric pressure around the wound through a sealed dressing to remove fluids and infectious material and to aid healing.
-
Service type: Durable medical equipment–assisted negative pressure wound therapy with topical application(s), wound assessment, and instruction(s) for ongoing care
-
Typical site of service: Outpatient clinic, physician office, wound care center, or other ambulatory care settings where durable medical equipment can be applied and managed
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.