Does 97607 require prior authorization?

No, 97607 does not require prior authorization (low confidence). No active coverage policies found for this code.

What is the Medicare reimbursement rate for 97607?

Medicare facility rate: $18.70. Non-facility rate: $367.41. Work RVU: 0.40.

HCPCS/CPT

No Prior Auth Required

No active coverage policies found for this code (low confidence)

Work RVU

0.40

Facility

$18.70

Non-Facility

$367.41

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.
Stage III or IV pressure ulcers are covered indications for SNaP negative pressure wound therapy.
Neuropathic (diabetic) ulcers are covered indications for SNaP negative pressure wound therapy.
Chronic ulcers present for at least 30 days (mixed etiology) are covered indications for SNaP negative pressure wound therapy.

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.