CPT 97598
Global ZZZ ActiveDbrdmt opn wnd addl 20cm/<
CPT 97598 Billing & Documentation Guide
CPT code 97598 (Dbrdmt opn wnd addl 20cm/<) is classified under Physical Medicine with a global period indicator of ZZZ. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 0.49, a non-facility practice expense RVU of 0.88, and a malpractice RVU of 0.06, a total non-facility RVU of 1.43 and facility RVU of 0.65. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $49.09, though rates vary from $42.65 to $61.63 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 97598, 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 97598 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
Add-on code (global concept does not apply)
MUE Limit (Medically Unlikely Edits)
Submitting more than 8 units of 97598 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 97598
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 0.49 | 0.49 |
| Practice Expense RVU | 0.88 | 0.1 |
| Malpractice RVU | 0.06 | 0.06 |
| Total RVU | 1.43 | 0.65 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 97598
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 | $52.82 | $21.99 | $49.93 - $61.63 | 29 |
| Florida | $49.76 | $23.62 | $47.48 - $52.03 | 3 |
| Georgia | $46.83 | $21.98 | $44.97 - $48.69 | 2 |
| Illinois | $48.65 | $23.48 | $46.33 - $50.62 | 4 |
| Michigan | $46.79 | $22.33 | $45.46 - $48.11 | 2 |
| North Carolina | $45.07 | $20.76 | $45.07 - $45.07 | 1 |
| New York | $52.66 | $23.59 | $45.7 - $56.08 | 5 |
| Ohio | $45.22 | $21.44 | $45.22 - $45.22 | 1 |
| Pennsylvania | $47.45 | $21.93 | $45.24 - $49.65 | 2 |
| Texas | $47.26 | $21.61 | $44.98 - $49.27 | 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 97598
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 97598 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 97598
What does CPT code 97598 mean? +
CPT code 97598 represents: Dbrdmt opn wnd addl 20cm/<. It's in the Physical Medicine category with a global period of ZZZ.
What is the Medicare reimbursement for CPT 97598? +
The 2026 Medicare national average non-facility payment for CPT 97598 is $49.09. Rates range from $42.65 to $61.63 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 97598? +
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 97598? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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