Does 97605 require prior authorization?

No, 97605 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 97605?

Medicare facility rate: $21.04. Non-facility rate: $42.09. Work RVU: 0.54.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

0.54

Facility

$21.04

Non-Facility

$42.09

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.

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.
Low-frequency, non-contact, non-thermal ultrasound (CPT 97610) is used for wound care to deliver continuous low-frequency ultrasonic energy and to atomize and deliver liquid to the wound bed.
Claims must be submitted with an ICD-10-CM code that represents the reason the procedure was done, billed to the highest level of specificity and linked to the procedure code.
Active wound care management may be billed using CPT codes 97597, 97598, 97602, 97605, 97606, 97607, and 97608 when medical record documentation supports the active wound procedures described by those codes.

L37228 — Wound Care

J05

A55909 — Billing and Coding: Wound Care

J05

L33631 — Outpatient Physical and Occupational Therapy Services

J06

A56566 — Billing and Coding: Outpatient Physical and Occupational Therapy Services

J06

L37166 — Wound Care

Ask Verity about documentation requirements, denial risks, or coverage in your state.