Billing and Coding: Wound Care

Traditional NPWT devices and wound care procedures (e.g., CPT 97597/97598 and debridement CPT 11042-11047) may be covered when documentation demonstrates medical necessity consistent with L37228 and applicable Medicare requirements; NPWT items are covered under the DME benefit per SSA §1861(s)(6). Several modalities and billing scenarios are excluded or limited: CPT 97602 is bundled for Part B, CPT 97026/97035/97028 are not payable per NCD/LCD, 11044 and 11047 are limited to hospital/ASC settings, and whirlpool (97022) cannot be separately billed with 97597/97598 for the same wound unless a different body part is treated. Documentation must support the billed CPT/HCPCS codes, including rationale for hydrotherapy and therapist skill, and providers should consult applicable LCDs/NCDs and consolidated billing/home health rules.

"Traditional negative pressure wound therapy (NPWT) devices, units, and supplies are covered under the Durable Medical Equipment (DME) benefit when they meet DME LCD coverage criteria and medical ne..."