CPT 97608: Negative Pressure Wound Therapy, Wounds >50 cm2

Medicare pays $415 and commercial payers pay $244 on average nationally for this procedure.

CPT code 97608 describes negative pressure wound therapy—application of controlled subatmospheric pressure via a sealed dressing to remove fluid and infectious material and promote healing for wounds with a total surface area greater than 50 cm2; service type: wound care/negative pressure wound therapy; typical site of service: outpatient wound care clinic, hospital wound care unit, or other ambulatory care settings where topical wound management is provided.

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.

Customize your policy alerts

Sign up for cpt 97608 policy alerts

Get alerted when payer policies referencing 97608 are released or updated.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

National Reimbursement Benchmarks

Across payers, Medicare mean rates for CPT 97608 sit noticeably higher than BUCA’s commercial average: Medicare mean $415.30 versus BUCA mean $243.70, reflecting Medicare’s concentration at the upper-middle of locality rates (median $405, P25 $377, P75 $435) compared with BUCA’s broader commercial center (P50 $180.50, P25 $99.20, P75 $351.90). This positions Medicare nearer to the top of the national distribution while BUCA aligns with many commercial payers’ mid-range means.

Dispersion (P75 minus P25) highlights variability across payers: Blue Cross Blue Shield shows a range of $240.00 ($381.20 - $144.20), UnitedHealth Group $288.00 ($343.90 - $55.90), Cigna $346.70 ($384.60 - $38.90), BUCA $252.70 ($351.90 - $99.20), and Aetna $189.70 ($210.00 - $23.00). Cigna has the widest interquartile spread, while Aetna is the tightest among these payers.

Explore openpayer tools

View all tools

CPT 97608: Negative Pressure Wound Therapy, Wounds >50 cm2

Medicare pays $415 and commercial payers pay $244 on average nationally for this procedure.

Customize your policy alerts

Sign up for cpt 97608 policy alerts

Get alerted when payer policies referencing 97608 are released or updated.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

National Reimbursement Benchmarks

National Payer Mean Reimbursement Rates

Clinical & Coding Specifications

Clinical Context

A 72-year-old male with chronic venous insufficiency and a non-healing ulcer of the lower leg presents to an outpatient wound-care clinic for evaluation. The wound measures 8 cm by 7 cm (56 cm2), has moderate serous drainage, and shows slough without signs of systemic sepsis. The clinician performs wound assessment, documents wound size, depth, surrounding skin condition, and reviews prior treatments (sharp debridement, dressings, compression). Given the wound surface area greater than 50 cm2 and slow healing over several weeks despite local care, the provider initiates negative pressure wound therapy (NPWT) using a portable system and applies a sealed dressing to create controlled subatmospheric pressure around the wound. The visit includes application of the NPWT dressing, connection to the device, instruction to patient/caregiver on device care and alarm management, and documentation of dressing components, wound assessment, and plan for follow-up in 48–72 hours for dressing check and potential dressing change. Typical sites of service for this procedure are outpatient wound-care centers, hospital outpatient departments, skilled nursing facilities, long-term acute care hospitals, and home health settings where the facility or clinician can apply and manage NPWT for wounds larger than 50 cm2.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`97607`	Negative pressure wound therapy, utilizing disposable, non‑durable medical equipment including provision of exudate management collection system, topical application(s), wound assessment, and instructions for ongoing care, per session; total wound(s) surface area less than or equal to 50 square centimeters	Alternative code for NPWT when total wound surface area is ≤ 50 cm2 and disposable, non‑durable equipment is used; select based on wound size and equipment type.
`97605`	Negative pressure wound therapy, utilizing durable medical equipment including topical application(s), wound assessment, and instruction(s) for ongoing care, per session; total wound(s) surface area less than or equal to 50 square centimeters	Related code when durable NPWT systems are used for smaller wounds (≤ 50 cm2) and durable equipment billing applies.
`97606`	Negative pressure wound therapy, utilizing durable medical equipment including topical application(s), wound assessment, and instruction(s) for ongoing care, per session; total wound(s) surface area greater than 50 square centimeters	Related durable-equipment NPWT code for wounds > 50 cm2; choose between `97608` and `97606` per payer rules and equipment classification.

Related Modifiers

9 rows

Modifier	Description	When to Use
22	Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…	- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
52	Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…	- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
53	Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…	- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
59	Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…	- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
62	Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…	- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
78	CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…	- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
80	CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…	- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…
81	Modifier -81 indicates a physician served as a minimal assistant surgeon for part—not all—of an operative procedure. Use when a physician’s assisting role is limited and does not represent full…	- Use CPT modifier -81 when a physician acts as a minimum assistant surgeon who assists during only part (a limited portion) of an operative procedure; append -81 to the primary surgical CPT code to…
82	Modifier 82 is appended to a surgical CPT code to indicate that an attending physician acted as an assistant because a qualified resident surgeon was unavailable. In teaching hospitals it documents…	- When to use: Append modifier 82 in teaching-hospital settings to indicate a physician served as an assistant surgeon because a qualified resident surgeon was unavailable (includes situations where…

Related Provider Taxonomies

8 rows

Taxonomy Code	Specialty	Notes
208600000X	Surgery Physician	A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of s…
207Q00000X	Family Medicine Physician	Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadt…
208D00000X	General Practice Physician	A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions.
237700000X	Hearing Instrument Specialist	Individuals who test hearing for the selection, adaptation, fitting, adjusting, servicing, and sale of hearing aids. Hearing Instrument Specialist is …
376K00000X	Nurse's Aide	(1) An unlicensed individual who is trained to function in an assistive role to the licensed nurse in the provision of patient/client activities as de…
103TP0016X	Prescribing (Medical) Psychologist	A licensed, doctoral-level psychologist authorized to prescribe and has undergone specialized education and training in preparation for prescriptive p…
261QP2000X	Physical Therapy Clinic/Center	An entity, facility, or distinct part of a facility providing diagnostic and treatment services related to physical rehabilitation. Physical therapy i…
374T00000X	Religious Nonmedical Nursing Personnel	Religious nonmedical nursing personnel are experienced in caring for the physical needs of nonmedical patients. For example, caring for the physical …

Related ICD-10-CM Codes

5 rows

ICD-10-CM Code	Description
S81.009A	Unspecified open wound, unspecified knee, initial encounter
L89.309	Pressure ulcer of unspecified buttock, unspecified stage
L89.899	Pressure ulcer of other site, unspecified stage
T81.31XA	Disruption of external operation (surgical) wound, not elsewhere classified, initial encounter
L97.909	Non-pressure chronic ulcer of unspecified part of unspecified lower leg with unspecified severity

Related Payer Policy Updates

Specialty: Home Health & Hospice1 / 3

10 rows

Policy	Payer	Effective Date
Home Health, Skilled, and Custodial Care Services (for Idaho Only)	UnitedHealthcare	2026-08-01
Private Duty Nursing Services (for Florida Only)	Colorado Rocky Mountain Health Plans	2026-08-01
Private Duty Nursing Services	Colorado Rocky Mountain Health Plans	2026-08-01
Private Duty Nursing Services (for New Jersey Only)	UnitedHealthcare	2026-08-01
Private Duty Nursing Services (for New Mexico Only)	UnitedHealthcare	2026-08-01
Private Duty Nursing Services (for Kentucky Only)	UnitedHealthcare	2026-08-01
Private Duty Nursing Services	Colorado Rocky Mountain Health Plans	2026-08-01
Private Duty Nursing Services (for Kansas Only)	UnitedHealthcare	2026-08-01
Home Health, Skilled, and Custodial Care Services (for Ohio Only)	UnitedHealthcare	2026-08-01
Home Health, Skilled, and Custodial Care Services	Colorado Rocky Mountain Health Plans	2026-07-01

CPT 97597: Selective Debridement of Open Wound ≤20 cm²

CPT-97598-ADDITIONAL-SELECTIVE-WOUND-DEBRIDEMENT-20CM2

CPT 97598: Selective Debridement, Additional 20 cm2

CPT-97602-NON-SELECTIVE-WOUND-DEBRIDEMENT

CPT 97602: Nonselective Debridement of Wound, Per Session

CPT-97605-NEGATIVE-PRESSURE-WOUND-THERAPY-SMALL-WOUND

CPT 97605: Negative Pressure Wound Therapy for Small Wounds

CPT-97606-NEGATIVE-PRESSURE-WOUND-THERAPY-LARGE-WOUND

CPT 97606: Negative-Pressure Wound Therapy with Durable Medical Equipment >50 cm2

CPT-97607-NEGATIVE-PRESSURE-WOUND-THERAPY-SMALL-WOUNDS

CPT 97607: Negative Pressure Wound Therapy for Small Wounds

CPT-97610-LOW-FREQUENCY-ULTRASOUND-WOUND-HEALING

CPT 97610: Low-Frequency Ultrasound Therapy for Wound Healing

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Explore openpayer tools

View all tools

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`97607`	Negative pressure wound therapy, utilizing disposable, non‑durable medical equipment including provision of exudate management collection system, topical application(s), wound assessment, and instructions for ongoing care, per session; total wound(s) surface area less than or equal to 50 square centimeters	Alternative code for NPWT when total wound surface area is ≤ 50 cm2 and disposable, non‑durable equipment is used; select based on wound size and equipment type.
`97605`	Negative pressure wound therapy, utilizing durable medical equipment including topical application(s), wound assessment, and instruction(s) for ongoing care, per session; total wound(s) surface area less than or equal to 50 square centimeters	Related code when durable NPWT systems are used for smaller wounds (≤ 50 cm2) and durable equipment billing applies.
`97606`	Negative pressure wound therapy, utilizing durable medical equipment including topical application(s), wound assessment, and instruction(s) for ongoing care, per session; total wound(s) surface area greater than 50 square centimeters	Related durable-equipment NPWT code for wounds > 50 cm2; choose between `97608` and `97606` per payer rules and equipment classification.

Related Modifiers

9 rows

Modifier	Description	When to Use
22	Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…	- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
52	Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…	- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
53	Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…	- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
59	Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…	- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
62	Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…	- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
78	CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…	- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
80	CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…	- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…
81	Modifier -81 indicates a physician served as a minimal assistant surgeon for part—not all—of an operative procedure. Use when a physician’s assisting role is limited and does not represent full…	- Use CPT modifier -81 when a physician acts as a minimum assistant surgeon who assists during only part (a limited portion) of an operative procedure; append -81 to the primary surgical CPT code to…
82	Modifier 82 is appended to a surgical CPT code to indicate that an attending physician acted as an assistant because a qualified resident surgeon was unavailable. In teaching hospitals it documents…	- When to use: Append modifier 82 in teaching-hospital settings to indicate a physician served as an assistant surgeon because a qualified resident surgeon was unavailable (includes situations where…

Related Provider Taxonomies

8 rows

Taxonomy Code	Specialty	Notes
208600000X	Surgery Physician	A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of s…
207Q00000X	Family Medicine Physician	Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadt…
208D00000X	General Practice Physician	A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions.
237700000X	Hearing Instrument Specialist	Individuals who test hearing for the selection, adaptation, fitting, adjusting, servicing, and sale of hearing aids. Hearing Instrument Specialist is …
376K00000X	Nurse's Aide	(1) An unlicensed individual who is trained to function in an assistive role to the licensed nurse in the provision of patient/client activities as de…
103TP0016X	Prescribing (Medical) Psychologist	A licensed, doctoral-level psychologist authorized to prescribe and has undergone specialized education and training in preparation for prescriptive p…
261QP2000X	Physical Therapy Clinic/Center	An entity, facility, or distinct part of a facility providing diagnostic and treatment services related to physical rehabilitation. Physical therapy i…
374T00000X	Religious Nonmedical Nursing Personnel	Religious nonmedical nursing personnel are experienced in caring for the physical needs of nonmedical patients. For example, caring for the physical …

Related ICD-10-CM Codes

5 rows

ICD-10-CM Code	Description
S81.009A	Unspecified open wound, unspecified knee, initial encounter
L89.309	Pressure ulcer of unspecified buttock, unspecified stage
L89.899	Pressure ulcer of other site, unspecified stage
T81.31XA	Disruption of external operation (surgical) wound, not elsewhere classified, initial encounter
L97.909	Non-pressure chronic ulcer of unspecified part of unspecified lower leg with unspecified severity

Related Payer Policy Updates

Specialty: Home Health & Hospice1 / 3

10 rows

Policy	Payer	Effective Date
Home Health, Skilled, and Custodial Care Services (for Idaho Only)	UnitedHealthcare	2026-08-01
Private Duty Nursing Services (for Florida Only)	Colorado Rocky Mountain Health Plans	2026-08-01
Private Duty Nursing Services	Colorado Rocky Mountain Health Plans	2026-08-01
Private Duty Nursing Services (for New Jersey Only)	UnitedHealthcare	2026-08-01
Private Duty Nursing Services (for New Mexico Only)	UnitedHealthcare	2026-08-01
Private Duty Nursing Services (for Kentucky Only)	UnitedHealthcare	2026-08-01
Private Duty Nursing Services	Colorado Rocky Mountain Health Plans	2026-08-01
Private Duty Nursing Services (for Kansas Only)	UnitedHealthcare	2026-08-01
Home Health, Skilled, and Custodial Care Services (for Ohio Only)	UnitedHealthcare	2026-08-01
Home Health, Skilled, and Custodial Care Services	Colorado Rocky Mountain Health Plans	2026-07-01

CPT 97597: Selective Debridement of Open Wound ≤20 cm²

CPT-97598-ADDITIONAL-SELECTIVE-WOUND-DEBRIDEMENT-20CM2

CPT 97598: Selective Debridement, Additional 20 cm2

CPT-97602-NON-SELECTIVE-WOUND-DEBRIDEMENT

CPT 97602: Nonselective Debridement of Wound, Per Session

CPT-97605-NEGATIVE-PRESSURE-WOUND-THERAPY-SMALL-WOUND

CPT 97605: Negative Pressure Wound Therapy for Small Wounds

CPT-97606-NEGATIVE-PRESSURE-WOUND-THERAPY-LARGE-WOUND

CPT 97606: Negative-Pressure Wound Therapy with Durable Medical Equipment >50 cm2

CPT-97607-NEGATIVE-PRESSURE-WOUND-THERAPY-SMALL-WOUNDS

CPT 97607: Negative Pressure Wound Therapy for Small Wounds

CPT-97610-LOW-FREQUENCY-ULTRASOUND-WOUND-HEALING

CPT 97610: Low-Frequency Ultrasound Therapy for Wound Healing

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

OpenPayer

CPT 97608: Negative Pressure Wound Therapy, Wounds >50 cm2

Sign up for cpt 97608 policy alerts

National Reimbursement Benchmarks

OpenPayer

CPT 97608: Negative Pressure Wound Therapy, Wounds >50 cm2

Sign up for cpt 97608 policy alerts

National Reimbursement Benchmarks

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Payer Policy Updates

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Payer Policy Updates

Related Codes

References

CPT 97608: Negative Pressure Wound Therapy, Wounds >50 cm2

Sign up for cpt 97608 policy alerts

National Reimbursement Benchmarks

CPT 97608: Negative Pressure Wound Therapy, Wounds >50 cm2

Sign up for cpt 97608 policy alerts

National Reimbursement Benchmarks

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Payer Policy Updates

Related Codes

What clinical situations indicate use of CPT 97608?

How does CPT 97608 differ from CPT 97607 and 97606?

What elements of the visit are described in the clinical context for coding CPT 97608?

In which sites of service is CPT 97608 typically performed?

What related diagnoses are commonly associated with billing CPT 97608?

References

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Payer Policy Updates

Related Codes

What clinical situations indicate use of CPT 97608?

How does CPT 97608 differ from CPT 97607 and 97606?

What elements of the visit are described in the clinical context for coding CPT 97608?

In which sites of service is CPT 97608 typically performed?

What related diagnoses are commonly associated with billing CPT 97608?

References