CPT 97606
Global XXX ActiveNeg prs wnd ther dme>50 sqcm
CPT 97606 Billing & Documentation Guide
CPT code 97606 (Neg prs wnd ther dme>50 sqcm) is classified under Physical Medicine with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 0.59, a non-facility practice expense RVU of 0.91, and a malpractice RVU of 0.01, a total non-facility RVU of 1.51 and facility RVU of 0.69. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $52.12, though rates vary from $45.99 to $65.88 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 97606, 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 97606 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 97606 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 97606
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 0.59 | 0.59 |
| Practice Expense RVU | 0.91 | 0.09 |
| Malpractice RVU | 0.01 | 0.01 |
| Total RVU | 1.51 | 0.69 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 97606
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 | $56.56 | $24.15 | $53.53 - $65.88 | 29 |
| Florida | $50.85 | $23.37 | $49.27 - $52.19 | 3 |
| Georgia | $49.14 | $23.01 | $47.22 - $51.05 | 2 |
| Illinois | $49.78 | $23.31 | $47.98 - $51.65 | 4 |
| Michigan | $48.72 | $23 | $47.83 - $49.6 | 2 |
| North Carolina | $48.28 | $22.72 | $48.28 - $48.28 | 1 |
| New York | $55.01 | $24.45 | $48.82 - $57.73 | 5 |
| Ohio | $47.79 | $22.79 | $47.79 - $47.79 | 1 |
| Pennsylvania | $50.01 | $23.19 | $47.92 - $52.1 | 2 |
| Texas | $50.05 | $23.08 | $47.68 - $52.2 | 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 97606
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 97606 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 97606
What does CPT code 97606 mean? +
CPT code 97606 represents: Neg prs wnd ther dme>50 sqcm. It's in the Physical Medicine category with a global period of XXX.
What is the Medicare reimbursement for CPT 97606? +
The 2026 Medicare national average non-facility payment for CPT 97606 is $52.12. Rates range from $45.99 to $65.88 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 97606? +
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 97606? +
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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