97598
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
0.49
Facility
$21.71
Non-Facility
$47.76
Documentation Required
- Claims must include an ICD-10-CM code that represents the reason the procedure was done, billed to the highest level of specificity, and linked to the appropriate procedure code.
- When a therapist performs active wound care management, the appropriate therapy modifier must be added to the CPT code and a therapy Revenue Code must be submitted; when a non-therapist performs the service, no therapy modifier is used and a non-therapy Revenue Code must be submitted.
- Medical record documentation must support use of surgical debridement codes (11000-11012, 11042-11047), including measurements taken after debridement and documentation of depth and surface area when applicable; documentation substantiating depth for CPT 11044 is encouraged.
- When billing an E/M code on the same day as a debridement, documentation must clearly establish that the E/M was a separately identifiable, reasonable and necessary service distinct from the debridement.
Key Coverage Criteria
- Active wound care management CPT codes 97597, 97598, 97605, 97606, 97607, and 97608 are billable when active wound care management services are performed.
- Surgical debridement CPT codes 11000-11012 and 11042-11047 are appropriate to report when surgical removal of devitalized tissue has been performed and the code selected reflects the deepest level of tissue removed.
- Low-frequency, non-contact, non-thermal ultrasound therapy (MIST Therapy) CPT code 97610 is allowable for treatment of a qualifying wound.
- Skilled selective debridement (CPT 97597, 97598) is covered when medically necessary and performed by a physician, NPP, or therapist acting within scope of practice and licensure.
- Skilled non-selective debridement (CPT 97602) is covered when medically necessary and performed by a physician, NPP, or therapist acting within scope of practice and licensure.
- Physical medicine and rehabilitation wound debridement codes (97597, 97598, 97602) may be billed by physicians, NPPs, or therapists when the services are medically necessary skilled debridement.
20 Active Policies
L37228 — Wound Care
J05
A55909 — Billing and Coding: Wound Care
J05
A56617 — Billing and Coding: Debridement Services
J06
L33614 — Debridement Services
J06
A55818 — Billing and Coding: Wound Care
Related Codes
Have a follow-up question?
Ask Verity about documentation requirements, denial risks, or coverage in your state.