CMS Pub. 100-04, ch. 10, § 90.3

Therapy Services

(Rev. 12382; Issued: 11-28-23; Effective: 01-01-24; Implementation:01-02-24)

The instructions in this section apply to disposable negative pressure wound therapy

(dNPWT) services provided during home health periods of care ending before January 1,

2024. Services provided during periods of care ending on or after January 1, 2024 are

billed on Type of Bill 032x. See section 40.2 for billing instructions.

Effective January 1, 2017, Medicare makes a separate payment amount for a disposable

negative pressure wound therapy (NPWT) device for a patient under a home health plan

of care. Payment is equal to the amount of the payment that would otherwise be made

under the Outpatient Prospective Payment System (OPPS).

Disposable NPWT services are billed using the following HCPCS codes:

• 97607 - Negative pressure wound therapy, (e.g., vacuum assisted drainage

collection), utilizing disposable, non-durable medical equipment including

provision of exudate management collection system, topical application(s), wound

assessment, and instructions for ongoing care, per session; total wound(s) surface

area less than or equal to 50 square centimeters.

• 97608 - Negative pressure wound therapy, (e.g., vacuum assisted drainage

collection), utilizing disposable, non-durable medical equipment including

provision of exudate management collection system, topical application(s), wound

assessment, and instructions for ongoing care, per session; total wound(s) surface

area greater than 50 square centimeters.

The HHA reports the HCPCS code with one of three revenue codes, depending on the

practitioner that provided the service:

• Skilled nurse – 0559

• Physical therapist – 042x

• Occupational therapy – 043x.

When using revenue codes 042x or 043x, the HHA should not use the therapy plan of

care modifiers (GO or GP) for NPWT services.

These HCPCS codes include payment for both performing the service and the disposable

NPWT device, which is defined as an integrated system comprised of a nonmanual

vacuum pump, a receptacle for collecting exudate, and dressings for the purposes of

wound therapy. Services related to the provision of NPWT using a disposable device that

do not encompass the provision of the entire integrated system should be billed per

existing HH PPS guidelines.

To avoid duplication of payment, for instances where the sole purpose for an HHA visit

is to perform NPWT using a disposable device, Medicare will not pay for a skilled

nursing or therapy visit under the HH PPS. Rather, performing NPWT using a disposable

device for a patient under a home health plan of care is be separately reimbursed the

OPPS amount. In this situation, the HHA bills only under TOB 034x. This visit is not

reported on the HH PPS claim (TOB 032x).

If NPWT using a disposable device is performed during the course of an otherwise

covered home health visit (e.g., to perform a catheter change), the visit would be covered

as normal. Performing NPWT using a disposable device will be separately reimbursed

the OPPS amount. In this situation, the HHA bills under TOB 034X and this visit is also

reported on the HH PPS claim (TOB 032x). The HHA must not include the time spent

performing NPWT in their visit charge or in the length of time reported for the visit on

the HH PPS claim.