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See a sample rate comparisonCPT 97605 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Neg Prs Wnd Ther Dme 50sqcm, Negative Pressure Wound Therapy Eg Vacuum Assisted Drainage Collection Utilizing Durable Medical Equipment Dme 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
| Key Fact | Detail |
|---|---|
| Service Type | Medicine Services and Procedures Physical Medicine and Rehabilitation Evaluations |
| Common Place of Service | 21 - Inpatient Hospital 11 - Office |
| Common Modifiers | 59 - Distinct Procedural Service GP - Services delivered under an outpatient physical therapy plan of care |
| Complexity Level | Low |
| Medicare Fee Schedule | $42.09 national non-facility rate (2026) · View Medicare rates for 97605 |
| Medicaid Fee Schedule | $32.67 median of the 7 states in the free preview · View Medicaid rates for 97605 |
National average reimbursement for CPT 97605 by major payers:
$48.57
$42.52
$55.95
$65.77
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CPT 97605
5 of 25 sample ratesHigher to lower in this preview
Karl Reisig
Poudre Valley Medical Group LLC
$44.75Published rateGe Yan
University Physicians Incorporated
$44.75Published rateMarc Kerman
University Physicians Incorporated
$44.75Published rateMichael Mikhail
Poudre Valley Medical Group LLC
$42.09Published rateMelford Allan Lazarte
Poudre Valley Medical Group LLC
$26.70Published rate
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See a sample payer proposalCPT 97605 vs. Other Physical Medicine and Rehabilitation Evaluations Codes
The CPT 97605 code is part of the Medicine Services and Procedures services used for Physical Medicine and Rehabilitation Evaluations. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 97605 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 97597-CPT | Low | Dbrdmt Opn Wnd 1st 20 Cm, Debridement Eg High Pressure Waterjet With Without Suction Sharp Selective Debridement With Scissors Scalpel And Forceps Open Wound Eg Fibrin Devitalized Epidermis And Or Dermis Exudate Debris Biofilm Including Topical Application S Wound Assessment Use Of A Whirlpool When Performed And Instruction S For Ongoing Care Per Session Total Wound S Surface Area First 20 Sq Cm Or Less |
| 97598-CPT | Low | Dbrdmt Opn Wnd Addl 20cm, Debridement Eg High Pressure Waterjet With Without Suction Sharp Selective Debridement With Scissors Scalpel And Forceps Open Wound Eg Fibrin Devitalized Epidermis And Or Dermis Exudate Debris Biofilm Including Topical Application S Wound Assessment Use Of A Whirlpool When Performed And Instruction S For Ongoing Care Per Session Total Wound S Surface Area Each Additional 20 Sq Cm Or Part Thereof List Separately In Addition To Code For Primary Procedure |
| 97602-CPT | Low | Wound S Care Non Selective, Removal Of Devitalized Tissue From Wound S Non Selective Debridement Without Anesthesia Eg Wet To Moist Dressings Enzymatic Abrasion Larval Therapy Including Topical Application S Wound Assessment And Instruction S For Ongoing Care Per Session |
| 97605-CPT | Low | Neg Prs Wnd Ther Dme 50sqcm, Negative Pressure Wound Therapy Eg Vacuum Assisted Drainage Collection Utilizing Durable Medical Equipment Dme 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 |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 97605. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 97605 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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