CPT 97605
Global XXX ActiveNeg prs wnd ther dme<=50sqcm
CPT 97605 Billing & Documentation Guide
CPT code 97605 (Neg prs wnd ther dme<=50sqcm) is classified under Physical Medicine with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 0.54, a non-facility practice expense RVU of 0.71, and a malpractice RVU of 0.01, a total non-facility RVU of 1.26 and facility RVU of 0.63. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $43.44, though rates vary from $38.58 to $54.4 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 97605, 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 97605 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
No global period (E/M and other non-procedural services)
MUE Limit (Medically Unlikely Edits)
Submitting more than 1 units of 97605 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 97605
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 0.54 | 0.54 |
| Practice Expense RVU | 0.71 | 0.08 |
| Malpractice RVU | 0.01 | 0.01 |
| Total RVU | 1.26 | 0.63 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 97605
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 | $46.92 | $22.03 | $44.51 - $54.4 | 29 |
| Florida | $42.48 | $21.37 | $41.21 - $43.57 | 3 |
| Georgia | $41.09 | $21.02 | $39.59 - $42.59 | 2 |
| Illinois | $41.65 | $21.32 | $40.21 - $43.11 | 4 |
| Michigan | $40.78 | $21.02 | $40.07 - $41.48 | 2 |
| North Carolina | $40.38 | $20.74 | $40.38 - $40.38 | 1 |
| New York | $45.8 | $22.33 | $40.8 - $48.01 | 5 |
| Ohio | $40.02 | $20.81 | $40.02 - $40.02 | 1 |
| Pennsylvania | $41.79 | $21.17 | $40.12 - $43.45 | 2 |
| Texas | $41.79 | $21.08 | $39.93 - $43.46 | 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 97605
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 97605 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 | Anesthesia service included in surgical procedure |
| 00102 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 00103 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 00104 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 00120 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 00124 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 00126 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 00140 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 00142 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 00144 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
Frequently Asked Questions, CPT 97605
What does CPT code 97605 mean? +
CPT code 97605 represents: Neg prs wnd ther dme<=50sqcm. It's in the Physical Medicine category with a global period of XXX.
What is the Medicare reimbursement for CPT 97605? +
The 2026 Medicare national average non-facility payment for CPT 97605 is $43.44. Rates range from $38.58 to $54.4 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 97605? +
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 97605? +
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