CPT 97607
Global XXX ActiveNeg prs wnd thr ndme<=50sqcm
CPT 97607 Billing & Documentation Guide
CPT code 97607 (Neg prs wnd thr ndme<=50sqcm) is classified under Physical Medicine with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 0.4, a non-facility practice expense RVU of 10.54, and a malpractice RVU of 0.06, a total non-facility RVU of 11 and facility RVU of 0.56. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $382.76, though rates vary from $316.8 to $523.55 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 97607, 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 97607 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 97607 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 97607
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 0.4 | 0.4 |
| Practice Expense RVU | 10.54 | 0.1 |
| Malpractice RVU | 0.06 | 0.06 |
| Total RVU | 11 | 0.56 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 97607
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 | $431.49 | $18.88 | $400.5 - $523.55 | 29 |
| Florida | $370.48 | $20.62 | $352.93 - $384.91 | 3 |
| Georgia | $351.63 | $18.97 | $329.77 - $373.49 | 2 |
| Illinois | $357.4 | $20.47 | $337.91 - $378.56 | 4 |
| Michigan | $346.75 | $19.32 | $337.04 - $356.46 | 2 |
| North Carolina | $343.1 | $17.76 | $343.1 - $343.1 | 1 |
| New York | $409.46 | $20.44 | $349.21 - $436.52 | 5 |
| Ohio | $336.8 | $18.43 | $336.8 - $336.8 | 1 |
| Pennsylvania | $360.45 | $18.9 | $338.43 - $382.47 | 2 |
| Texas | $361.89 | $18.58 | $335.58 - $387.63 | 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 97607
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 97607 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 97607
What does CPT code 97607 mean? +
CPT code 97607 represents: Neg prs wnd thr ndme<=50sqcm. It's in the Physical Medicine category with a global period of XXX.
What is the Medicare reimbursement for CPT 97607? +
The 2026 Medicare national average non-facility payment for CPT 97607 is $382.76. Rates range from $316.8 to $523.55 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 97607? +
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 97607? +
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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