CPT 97597
Global 000 ActiveDbrdmt opn wnd 1st 20 cm/<
CPT 97597 Billing & Documentation Guide
CPT code 97597 (Dbrdmt opn wnd 1st 20 cm/<) is classified under Physical Medicine with a global period indicator of 000. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 0.75, a non-facility practice expense RVU of 2.24, and a malpractice RVU of 0.05, a total non-facility RVU of 3.04 and facility RVU of 0.93. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $105.08, though rates vary from $90.18 to $136.59 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 97597, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 97597 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
Endoscopic or minor procedure with related preoperative and postoperative work performed on the same day
MUE Limit (Medically Unlikely Edits)
Submitting more than 1 units of 97597 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
RVU Breakdown, CPT 97597
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 0.75 | 0.75 |
| Practice Expense RVU | 2.24 | 0.13 |
| Malpractice RVU | 0.05 | 0.05 |
| Total RVU | 3.04 | 0.93 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 97597
State-level averages across all MAC localities. Non-facility rates typically apply to office-based services; facility rates apply to hospital outpatient / inpatient.
| State | Non-Facility | Facility | Range (Non-Fac) | Localities |
|---|---|---|---|---|
| California | $115.38 | $31.99 | $108.37 - $136.59 | 29 |
| Florida | $103.37 | $32.66 | $99.09 - $107.16 | 3 |
| Georgia | $98.47 | $31.23 | $93.78 - $103.15 | 2 |
| Illinois | $100.62 | $32.53 | $95.97 - $105.02 | 4 |
| Michigan | $97.66 | $31.48 | $95.25 - $100.07 | 2 |
| North Carolina | $95.92 | $30.17 | $95.92 - $95.92 | 1 |
| New York | $111.97 | $33.35 | $97.3 - $118.71 | 5 |
| Ohio | $95.04 | $30.7 | $95.04 - $95.04 | 1 |
| Pennsylvania | $100.35 | $31.31 | $95.31 - $105.38 | 2 |
| Texas | $100.4 | $31.01 | $94.69 - $105.74 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
NCCI Bundling Edits, CPT 97597
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 97597 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 00100 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 00102 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 00103 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 00104 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 00120 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 00124 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 00126 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 00140 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 00142 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 00144 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
Frequently Asked Questions, CPT 97597
What does CPT code 97597 mean? +
CPT code 97597 represents: Dbrdmt opn wnd 1st 20 cm/<. It's in the Physical Medicine category with a global period of 000.
What is the Medicare reimbursement for CPT 97597? +
The 2026 Medicare national average non-facility payment for CPT 97597 is $105.08. Rates range from $90.18 to $136.59 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 97597? +
Medicine section spans a wide range: therapy services use GP/GO/GN (PT/OT/SLP plans of care) and KX (above cap with documentation). Drug administration uses JW (waste) and JZ (no waste). Professional/technical split applies to some diagnostic codes.
What bundling edits apply to CPT 97597? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
Get the full PayerReady toolkit
Free access to CPT/ICD-10 lookup, denial appeals, fee comparator, and claim auditing with credentialing enrollment.
Start free →Run this code through our claim audit tool
Check NCCI bundling, MUE limits, and modifier logic before submission.
Try the auditor →Did this page help?
Quick signal so we know what to improve.
If you want a code reference page that doesn't exist yet, email coding@payerready.com.
Tell us what's missing or wrong: coding@payerready.com. We respond within 5 business days.
Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
Powered by 11K CPT · 98K ICD-10 · 860K MPFS rates · 4.5M NCCI edits · 9.5M NPIs. Our data methodology · About our coding team