CPT 97608
Global XXX ActiveNeg prs wnd ther ndme>50sqcm
CPT 97608 Billing & Documentation Guide
CPT code 97608 (Neg prs wnd ther 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 0.45, a non-facility practice expense RVU of 11.35, and a malpractice RVU of 0.08, a total non-facility RVU of 11.88 and facility RVU of 0.65. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $413.27, though rates vary from $342.05 to $564.78 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 97608, 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 97608 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 97608 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 97608
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 0.45 | 0.45 |
| Practice Expense RVU | 11.35 | 0.12 |
| Malpractice RVU | 0.08 | 0.08 |
| Total RVU | 11.88 | 0.65 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 97608
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 | $465.6 | $21.76 | $432.21 - $564.78 | 29 |
| Florida | $400.6 | $24.25 | $381.47 - $416.43 | 3 |
| Georgia | $379.91 | $22.08 | $356.37 - $403.45 | 2 |
| Illinois | $386.5 | $24.06 | $365.33 - $409.21 | 4 |
| Michigan | $374.77 | $22.56 | $364.17 - $385.37 | 2 |
| North Carolina | $370.44 | $20.48 | $370.44 - $370.44 | 1 |
| New York | $442.3 | $23.85 | $377.05 - $471.7 | 5 |
| Ohio | $363.84 | $21.38 | $363.84 - $363.84 | 1 |
| Pennsylvania | $389.35 | $21.95 | $365.57 - $413.13 | 2 |
| Texas | $390.82 | $21.54 | $362.49 - $418.52 | 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 97608
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 97608 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 97608
What does CPT code 97608 mean? +
CPT code 97608 represents: Neg prs wnd ther ndme>50sqcm. It's in the Physical Medicine category with a global period of XXX.
What is the Medicare reimbursement for CPT 97608? +
The 2026 Medicare national average non-facility payment for CPT 97608 is $413.27. Rates range from $342.05 to $564.78 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 97608? +
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 97608? +
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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