Negative Pressure Wound Therapy (NPWT) Billing & CPT Coding Guide 2025 (97605–97608)
Blog Outline
- Introduction
- What Is Negative Pressure Wound Therapy (NPWT)
- NPWT CPT Code Overview (97605–97608)
- HCPCS Codes for NPWT Supplies and Equipment
- Medicare and Payer Coverage Rules for NPWT Billing (LCD L33821)
- Documentation Requirements for NPWT Billing
- Common NPWT Billing Errors and How to Avoid Them
- NPWT Billing Examples (Facility vs Home Use)
- NPWT Billing Accuracy Checklist (2025 Edition)
Introduction
Negative Pressure Wound Therapy (NPWT), often referred to as wound VAC therapy, has become a cornerstone in the management of chronic, surgical, and diabetic wounds. By applying controlled suction to a wound bed, NPWT accelerates healing, reduces infection risk, and promotes tissue regeneration. However, from a medical billing perspective, NPWT remains one of the most complex and frequently misbilled procedures in wound care. The distinction between durable pump systems and disposable NPWT devices, as well as proper selection among CPT codes 97605 – 97608, directly impacts reimbursement. In 2025, both Medicare LCD L33821 and private payers have refined their coverage criteria for NPWT—especially regarding treatment duration, device type, and medical necessity documentation. Billing errors or incomplete notes can lead to denials, downcoding, or audits under Medicare’s post-payment review programs.
This detailed NPWT billing and CPT coding guide (2025) helps wound care providers, coders, and long-term care facilities:
✅ Identify the correct CPT and HCPCS codes for NPWT based on wound size and device type.
✅ Document clinical details to meet Medicare and payer documentation requirements.
✅ Avoid common NPWT claim errors and unbundling issues.
✅ Access a downloadable NPWT Billing Checklist for compliance assurance.
Whether your facility manages outpatient wound therapy, inpatient long-term care, or home-based wound management, this guide ensures each NPWT claim meets compliance, medical necessity, and coding integrity standards.
You might be interested in: Wound Care Billing Services
What Is Negative Pressure Wound Therapy (NPWT)?
Negative Pressure Wound Therapy (NPWT) — also known as vacuum-assisted wound closure or simply wound VAC — is an advanced wound management technique that uses controlled suction to promote healing in complex or non-healing wounds. The therapy involves placing a foam or gauze dressing over the wound, sealing it with an adhesive drape, and connecting it to a pump that applies negative pressure (suction). This gentle suction:
- Removes exudate and infectious material
- Promotes granulation tissue formation
- Reduces wound edema
- Increases local blood flow and oxygenation
While clinically effective, NPWT introduces significant coding and billing complexity, because both the therapy itself (CPT codes) and the device supplies (HCPCS codes) are separately governed by payer rules.
Clinical vs Billing Perspective
| Clinical View | Billing View |
|---|---|
| Promotes wound healing through controlled suction | Coded using CPT 97605–97608, depending on wound area and device type |
| Used for chronic, post-surgical, and diabetic wounds | Requires documentation of wound size, type, and medical necessity |
| Managed in hospitals, clinics, or at home | Facility vs home billing follows different CPT and HCPCS structures |
Two Main NPWT Categories for Billing
NPWT is billed differently depending on the type of device used and the care setting.
1. Traditional (Durable) NPWT Systems
- Used in clinics, wound care centers, or hospitals
- Device is reusable (DME pump-based)
- CPT codes: 97605 (≤50 sq cm) and 97606 (>50 sq cm)
- Supplies (dressings, canisters) often billed separately under HCPCS A6550 and A7000
- Typically applied and managed by clinicians or nursing staff
Example Documentation Note
Negative pressure wound therapy applied to the right heel ulcer (5 × 4 cm = 20 sq cm) using a durable pump system at -125 mmHg. Dressing sealed with a canister and connected to suction. The patient tolerated the procedure well.
2. Disposable NPWT Systems
- Designed for home or post-acute care
- Small, portable, single-use device (no external pump)
- CPT codes: 97607 (≤50 sq cm) and 97608 (>50 sq cm)
- Dressing supplies are bundled within these CPT codes (not billed separately)
- Used when patients transition from hospital to home or skilled nursing facility
Example Documentation Note
Disposable NPWT device applied to abdominal incision (6 × 9 cm = 54 sq cm). Wound sealed with pre-packaged disposable system, continuous suction applied at -80 mmHg.
🧠 Key Billing Takeaway
- ✅ Durable systems (97605–97606) → Outpatient/Facility CPT billing + HCPCS supply codes
- ✅ Disposable systems (97607–97608) → Home/DME CPT billing, supplies included in CPT
This distinction forms the foundation of NPWT coding accuracy — the device type and wound area determine which code family applies.
Many payers require documented wound preparation before NPWT initiation. If debridement was performed before NPWT, ensure that both are properly documented and billed for separate wound care sessions. For accurate documentation, see our Wound Debridement CPT Coding Guide (97597–11047) to ensure compliance before starting NPWT billing.
NPWT CPT Code Overview (97605–97608)
Choosing the correct Negative Pressure Wound Therapy (NPWT) CPT code depends on two factors:
- Wound size (≤ or > 50 sq cm)
- Type of NPWT system used (durable vs disposable)
Below is a detailed breakdown of all four NPWT CPT codes used in 2025:
NPWT CPT Code Table for 2025
| CPT Code | Description | Wound Area | Device Type | Setting / Billing Context |
|---|---|---|---|---|
| CPT 97605 | Negative Pressure Wound Therapy (NPWT), utilizing durable pump system | ≤ 50 sq cm | Durable (reusable system) | Facility, outpatient wound clinic |
| CPT 97606 | NPWT, utilizing durable pump system | > 50 sq cm | Durable (reusable system) | Facility, outpatient wound clinic |
| CPT 97607 | NPWT using disposable, non-durable device | ≤ 50 sq cm | Disposable (portable system) | Home or long-term care setting |
| CPT 97608 | NPWT using disposable, non-durable device | > 50 sq cm | Disposable (portable system) | Home or long-term care setting |
How to Choose Between NPWT CPT Codes while Billing
1️⃣ Determine the Device Type
2️⃣ Calculate Total Wound Surface Area
3️⃣ Bill by Wound, Not by Device
Example Documentation for CPT Selection in NPWT Billing
Clinical Scenario
A 68-year-old patient presents with two chronic ulcers — one on the left calf (4 × 4 cm) and one on the right heel (6 × 9 cm).
Documentation Excerpt
NPWT applied to left calf ulcer (16 sq cm) and right heel ulcer (54 sq cm) using durable pump system at -125 mmHg. Both wounds sealed with foam and drape; exudate removed via canister. Treatment tolerated well.
Coding
- CPT 97605 – First wound (≤ 50 sq cm)
- CPT 97606-59 – Second wound (> 50 sq cm, modifier for separate site)
📌 Use modifier 59 only when NPWT is applied to distinct anatomical sites.
HCPCS Codes for NPWT Supplies and Equipment
Alongside CPT coding for the NPWT procedure (97605 – 97608), wound care providers must also bill correctly for supplies and equipment when using durable NPWT systems. These supply codes are billed separately under HCPCS Level II and play a crucial role in reimbursement.
Key HCPCS Codes for NPWT in 2025
| HCPCS Code | Description | Billing Context | Bundled? |
|---|---|---|---|
| HCPCS A6550 | Dressing set for negative pressure wound therapy (for use with durable pump) | Use with CPT 97605–97606 | No — bill separately |
| HCPCS A7000 | Canister set for NPWT pump | Use with CPT 97605–97606 | No — bill separately |
| HCPCS E2402 | Negative pressure wound therapy electrical pump (rental or purchase) | Billed by DME supplier | No — equipment rental code |
| HCPCS A9272 | Wound suction, disposable, for home use | Use when disposable system is used outside CPT 97607–97608 | Sometimes bundled (check payer) |
When to Bill HCPCS with CPT Codes
- Facility or clinic-based NPWT (Durable systems):
CPT 97605 or 97606 + HCPCS A6550 (dressing) and A7000 (canister).
These are typically billed per dressing kit used, not per wound. - Home health or DME setting:
CPT 97607 or 97608 includes dressing and equipment — do not bill HCPCS supplies separately.
Example
NPWT performed using a durable pump system with foam dressing (A6550) and canister change (A7000). Documentation supports medical necessity and daily therapy continuation.
Medicare Coverage Notes
According to Medicare LCD L33821 and Policy Article A55636:
- A6550 and A7000 may only be billed if NPWT is covered under the patient’s active wound management plan.
- E2402 (pump) requires DME supplier credentialing and prior authorization under some MACs.
- Disposable devices (CPT 97607/97608) do not require separate HCPCS billing.
Wound Care Bundling and Unbundling Guidelines
| Scenario | Can You Bill HCPCS? | Explanation |
|---|---|---|
| NPWT with reusable pump (facility or wound clinic) | ✅ Yes | CPT + A6550 + A7000 |
| NPWT using disposable, portable system (home use) | 🚫 No | CPT already includes supplies |
| NPWT with DME rental pump (E2402) | ✅ Yes | Rental billed separately via DME |
| NPWT with home health bundled service | 🚫 No | Supplies covered under home health episode |
Medicare and Payer Coverage Rules for NPWT Billing (LCD L33821)
Medicare LCD L33821 — The Core Policy for NPWT Billing
Medicare Local Coverage Determination (LCD) L33821 governs reimbursement for Negative Pressure Wound Therapy (NPWT) under Medicare Part B. It defines when NPWT is considered medically necessary, the types of wounds eligible, and how continued therapy must be justified. Under this LCD,
NPWT is covered when:
- The wound is chronic, acute, traumatic, or post-surgical and has failed to respond to standard wound therapy.
- There is adequate wound bed preparation (e.g., debridement performed) before NPWT application.
Documentation demonstrates ongoing progress (e.g., wound size reduction, tissue granulation)
NPWT is not covered,
if:
- The wound is dry or covered with eschar (no drainage).
- There is active osteomyelitis or necrotic tissue that has not been debrided.
- The patient’s overall health precludes wound healing (e.g., untreated infection or poor perfusion).
Private Payer and Medicaid Variations
| Payer Type | Pre-Authorization | Coverage Limitations | Notes |
|---|---|---|---|
| Medicare Part B | Not required initially; continued coverage after 30 days needs progress note | LCD L33821 governs documentation | Progress must be demonstrated |
| Medicare Advantage | ✅ Usually required | May impose duration caps (e.g., 12 weeks) | Requires NPWT vendor or DME authorization |
| Commercial Payers (Aetna, Cigna, BCBS) | ✅ Required | May require submission of wound images | Adhere to payer-specific clinical criteria |
| Medicaid (State-specific) | ✅ Often required | May limit disposable device coverage | Prior approval required for E2402 pumps |
Medicare Documentation Requirements for NPWT
Medicare auditors often deny claims for NPWT due to incomplete wound documentation. Each claim must include:
- Date of NPWT initiation and treating provider credentials
- Wound type and location
- Wound dimensions before and after therapy
- Device type (durable or disposable) and negative pressure level used
- Medical necessity statement: “Failure of conventional therapy over X weeks”
- Evidence of progress (granulation, size reduction, etc.)
Documentation Requirements for NPWT Billing
Accurate documentation is the backbone of successful Negative Pressure Wound Therapy (NPWT) billing. Even if the correct CPT code (97605–97608) is used, incomplete or vague notes can lead to denials, downcoding, or audit triggers — especially under Medicare LCD L33821 and commercial payer reviews. In 2025, payers are placing heightened emphasis on EHR data consistency and clinical justification to prevent fraud and overbilling. Each NPWT claim must be supported by precise, measurable, and timely clinical documentation.
Essential NPWT Documentation Elements
To ensure compliance, your wound care note should include the following six components:
| Documentation Element | Required Detail | Example Entry |
|---|---|---|
| Wound Location & Type | Specify anatomical site and wound etiology | “Stage 3 pressure ulcer, left heel” |
| Wound Dimensions | Record length × width × depth (in cm) before and after NPWT application | “Pre-treatment: 4.0 × 3.5 × 1.2 cm; Post-treatment: 3.6 × 3.2 × 1.0 cm” |
| Device Type | Identify durable pump or disposable single-use system | “Durable VAC pump used at -125 mmHg continuous suction” |
| Pressure Setting & Frequency | Record pressure (mmHg), cycle type, and dressing change frequency | “Continuous mode at -125 mmHg; dressing changed every 48 hours” |
| Medical Necessity Statement | Justify NPWT use after failure of conventional therapy | “NPWT initiated after 4 weeks of standard wound dressings without improvement” |
| Clinical Progress Over Time | Show measurable improvement or ongoing need | “50% reduction in wound size after 3 weeks; continued therapy medically necessary” |
Clinical Note Example
“Applied negative pressure wound therapy (NPWT) to the right lower leg venous ulcer (4 × 4 × 1 cm). Durable pump system used at -125 mmHg continuous suction. Dressing changed every 48 hours. Wound granulating well, showing 30% reduction in area over two weeks. Continued NPWT justified per LCD L33821. Supplies: A6550 ×1, A7000 ×1.”
This example meets Medicare Part B, Medicare Advantage, and commercial payer audit standards.
Pro Tips for Documentation Success
- Template consistency: Use a structured EHR template with mandatory fields (size, depth, suction pressure, and rationale).
- Photo evidence: Attach wound photos if your MAC or private payer requires them for ongoing NPWT coverage.
- CPT alignment: Ensure the wound size and device type recorded in the note match the CPT code billed.
- Separate encounters: If NPWT and debridement occur on different wounds or days, create distinct progress notes for each.
→ For procedural documentation examples, see our Wound Debridement CPT Coding Guide (97597 – 11047).
Common NPWT Billing Errors and How to Avoid Them
Even when providers use the correct NPWT CPT codes (97605–97608), documentation and modifier mistakes can still cause rejections or compliance reviews.
Below are the top NPWT-specific billing pitfalls — and how to prevent them.
1. Reporting the Wrong CPT Family (Durable vs Disposable NPWT)
Issue
Coders often confuse durable pump-based NPWT (97605–97606) with disposable single-use systems (97607–97608).
This error leads to overpayments, duplicate billing, or claim retraction notices during audits.
How to Avoid
> Verify the device type documented in the clinical note.
> Bill durable NPWT with A6550 and A7000 (if applicable).
> Do not bill HCPCS supplies with disposable NPWT (97607–97608).
> Cross-reference the wound size and CPT code family before submission.
2. Missing or Inaccurate Wound Measurements
Issue
Claims missing pre- and post-treatment wound size are routinely denied by Medicare and private payers under LCD L33821.
Auditors use these measurements to validate medical necessity and continued progress.
How to Avoid
> Document wound length, width, and depth before and after therapy.
> Record in centimeters and calculate the surface area (cm²).
> Update measurements at each dressing change or billing date.
For a structured example of compliant note-taking, refer to Documentation Requirements for NPWT Billing.
3. Billing Both CPT and HCPCS Supplies for Disposable NPWT
Issue
Some providers mistakenly bill A6550/A7000 supplies alongside 97607/97608.
However, disposable NPWT codes already include supplies and equipment.
How to Avoid
> Bill HCPCS supply codes only with durable NPWT (97605–97606).
> Check your EHR’s billing rules to prevent automatic HCPCS attachments.
> Verify payer bundling policies — especially for Medicare Advantage.
For reference, see HCPCS Codes for NPWT Supplies and Equipment.
4. Using Modifiers Incorrectly
Issue
Improper modifier usage (or omission) leads to bundling denials under NCCI edits.
Common mistakes include missing modifier 59, using 25 incorrectly, or omitting KX under LCD rules.
How to Avoid
> Use modifier 59 for separate anatomical sites (distinct NPWT wounds).
> Use modifier KX only when all LCD documentation requirements are met.
> Avoid modifier 25 unless an unrelated E/M visit occurred the same day.
> Always confirm modifier logic in your claim scrubber or clearinghouse rules.
5. Overbilling for NPWT Sessions Without Documented Progress
Issue
Medicare and commercial payers deny repeat NPWT claims when no measurable improvement is documented beyond the initial 30 days.
This triggers Targeted Probe & Educate (TPE) audits.
How to Avoid
> Track wound progress using sequential notes and photos.
> Include improvement statements (e.g., “40% reduction in wound size since initiation”).
> Discontinue NPWT when wound closure or transition to other therapy is clinically appropriate.
6. Incorrect ICD-10 Mapping
Issue
NPWT CPT codes must correspond to a valid ICD-10 wound diagnosis that supports medical necessity.
Incorrect linkage can lead to rejections under Medicare LCD edits.
How to Avoid
> Match ICD-10 codes to wound etiology:
- L97.- (non-pressure chronic ulcers)
- L89.- (pressure ulcers)
- T81.89 (post-surgical wound complications)
> Use line-item ICD linkage for each CPT.
> Review your MAC’s local coverage database for approved diagnosis lists.
7. Missing Progress Evidence for Continued Therapy
Issue
Reimbursement beyond the first 30 days requires documentation showing objective healing.
Failure to include progress notes causes LCD violations.
How to Avoid
> Record wound measurements at least once every 2–3 visits.
> Attach before/after photos if required by your payer.
> Document physician or NP review at 30-day intervals.
NPWT Billing Examples (Facility vs Home Use)
One of the biggest challenges for wound care providers is deciding how to bill NPWT correctly based on the care setting.
Whether performed in a wound clinic, hospital outpatient department, or home health/DME setup, the CPT, HCPCS, and modifier combinations vary significantly.
Here are clear, practical billing examples to help you navigate both scenarios in compliance with 2025 payer standards.
Example 1: Facility-Based NPWT (Durable Pump System)
🏠 Clinical Scenario
A 67-year-old patient with a post-surgical wound on the left thigh receives NPWT using a durable pump system at a wound care clinic.
The wound measures 6.0 × 9.0 cm (54 sq cm). Dressing and canister were replaced during the session.
🧾 Documentation Note
Applied NPWT to left thigh surgical wound using durable pump system at -125 mmHg continuous suction.
Dressing changed with foam kit (A6550 ×1); canister replaced (A7000 ×1). Wound size: 6 × 9 × 1.2 cm pre-therapy. Tolerated procedure well.
📄 Billing Summary
| Code Type | Code | Description |
|---|---|---|
| CPT | 97606 | NPWT > 50 sq cm, durable pump |
| HCPCS | A6550 | Dressing kit for NPWT |
| HCPCS | A7000 | Canister set for NPWT pump |
| ICD-10 | T81.89XA | Postprocedural wound complication |
| Modifier | KX | Documentation meets LCD L33821 coverage |
| POS | 11 | Office / Wound care clinic |
Key Notes
✅ Supplies billed separately for durable NPWT.
✅ Modifier KX confirms LCD-compliant documentation.
✅ Facility claim submitted on CMS-1500 or UB04 form depending on ownership model.
Example 2: Home-Based NPWT (Disposable Device)
🏠 Clinical Scenario
A 72-year-old diabetic patient with a chronic plantar ulcer transitions to home-based NPWT using a disposable single-use device.
The wound area measures 4 × 4 cm (16 sq cm), and supplies are included in the system.
🧾 Documentation Note
Applied single-use disposable NPWT system to right plantar ulcer (16 sq cm). Continuous suction -80 mmHg. Wound shows moderate drainage and early granulation. Follow-up in 5 days.
📄 Billing Summary
| Code Type | Code | Description |
|---|---|---|
| CPT | 97607 | NPWT ≤ 50 sq cm using disposable system |
| HCPCS | — | Supplies bundled within CPT |
| ICD-10 | L97.421 | Non-pressure chronic ulcer of right heel, limited to breakdown of skin |
| Modifier | RT | Right side (if payer requires) |
| POS | 12 | Home setting |
Key Notes
✅ Supplies not billed separately — bundled in CPT 97607.
✅ No KX modifier required (disposable systems exempt from DME LCD).
✅ Ideal for DME billing or physician-supervised home therapy.
Example 3: Multiple NPWT Wounds (Separate Sites)
🏠 Clinical Scenario
A 64-year-old patient has two NPWT-treated wounds — one left heel (30 sq cm) and one right lateral leg (70 sq cm) — both using durable pump systems.
📄 Billing Summary
| Code Type | Code | Description |
|---|---|---|
| CPT | 97605 | NPWT ≤ 50 sq cm (left heel) |
| CPT | 97606-59 | NPWT > 50 sq cm (right leg) |
| HCPCS | A6550 ×2 | Separate dressing kits per wound |
| HCPCS | A7000 ×1 | Shared canister |
| ICD-10 | L89.623, L89.623 | Pressure ulcer codes (distinct sites) |
| Modifier | 59 | Distinct procedural service |
| POS | 22 | Outpatient hospital |
Key Notes
✅ Modifier 59 prevents NCCI bundling.
✅ Document each wound individually in the clinical note.
✅ Attach wound photos for audit-proof claims.
NPWT Billing Accuracy Checklist (2025 Edition)
📄 Download the NPWT Billing Accuracy Checklist (2025 PDF)
Get a printer-friendly version of this checklist for your billing or compliance team.
Accurate NPWT billing requires more than code familiarity — it demands procedural precision, LCD compliance, and documentation excellence. By following this checklist and maintaining consistent EHR documentation, wound care providers can reduce denials, improve cash flow, and stay audit-ready year-round.
Ready to eliminate NPWT billing errors and strengthen compliance?
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