The correct CPT code for a wound vac change depends on whether your device is durable or disposable and on the total wound surface area measured in square centimeters. For a durable NPWT device on a wound ≤50 cm, use CPT 97605. For a wound exceeding 50 cm² with the same durable equipment, use the 97606 CPT code.
Choosing the wrong code, or billing a dressing-change code when a full NPWT session was performed, is one of the most audited billing errors in wound care today.
What Is the CPT Code for Wound Vac Change?
The CPT codes for a wound vac change (negative pressure wound therapy – NPWT) are 97605–97608. These codes include topical wound treatment, wound assessment, and patient training for follow-up care, all in one session code.
A “wound vac change” refers to the removal of the sealed dressing and wound filler, wound assessment, and placement of a new dressing with continued negative pressure. This session, not just the change in dressing, is the key to reporting CPT 97605 or 97606.
If you just change the protective dressing and do not complete an active session of NPWT, do not bill 97605 or 97606. The dressing change is not separately billable under these codes. This is confirmed in the CMS Article A53001.
97605 vs. 97606: What Is the Difference?
Both codes describe the application of wound VAC CPT services using a reusable, electronically powered DME device. The only distinction is wound size.
| CPT Code | Device Type | Wound Surface Area | Setting |
| 97605 | Durable (DME) | ≤ 50 cm² | Office, outpatient, SNF Part B, facility |
| 97606 | Durable (DME) | > 50 cm² | Office, outpatient, SNF Part B, facility |
| 97607 | Disposable (non-DME) | ≤ 50 cm² | Same as above |
| 97608 | Disposable (non-DME) | > 50 cm² | Same as above |
When Is the Application of Wound VAC CPT Code Billable?
The application of wound vac CPT code is billable when the provider personally performs a complete NPWT session on an open wound using a durable device. The following 5 conditions must all be true:
- The wound is an open wound, not a surgically closed incision used merely as a dressing
- The equipment is a durable pump (e.g., accessible to an electric outlet) owned or located in the clinic or facility
- The provider is present, providing direct patient contact
- Wound assessment is fully documented (including dimensions)
- The service isn’t bundled with the same-day surgical procedure in the same anatomical region (NCCI edits apply)
What Wound Types Qualify?
NPWT is supported for the following open wound categories:
- Diabetic foot ulcers (most common outpatient use)
- Venous stasis ulcers
- Pressure injuries (Stage III and IV)
- Open traumatic wounds (not repaired)
- Surgically repaired wounds with delayed healing (open, not sutured)
- Burns and dehisced wounds
Documentation Requirements for CPT 97605 and 97606
Documentation is the most common reason for NPWT claim denials and audits. Every session note must include the following 8 elements:
- Wound location: anatomical location with standard terminology
- Wound size: length x width in centimeters (and depth if applicable)
- Total surface area: confirms 97605 (vs. 97606)
- Device: confirm the pump is durable (DME), not disposable
- Pressure settings: record negative pressure settings (e.g., -125 mmHg)
- Wound status: exudate, granulation tissue, signs of infection
- Medical necessity: reason for continued NPWT
- Who performed the service: individual contact is needed
Frequency of billing: CPT 97605 has a MUE (Medically Unlikely Edit) of 1 unit per day. It may be reported once a day, if supported by documentation. But it can’t be billed more than 1 unit per day per patient.
Place of Service and Inpatient Rules
In non-facility sites, such as physician office (POS 11), independent clinic (POS 49), and SNF Part B (POS 32), providers bill the professional component and can receive additional payment for the NPWT session.
Reimbursement rules change in the facility/inpatient rules for inpatient hospitals (POS 21) and on-campus outpatient hospitals (POS 22). Typically, in the facility setting, NPWT is included in the facility’s diagnosis-related group (DRG) payment. Only when the physician provides the entire service, has face-to-face contact, and bills for a separate session is separate professional payment allowed.
Medicare and Payer Coverage Rules in 2026
Medicare reimburses NPWT (CPT 97605 and 97606) when the medical necessity is apparent. Local Coverage Determinations (LCDs) determine covered wound types for each MAC. The 2016 key compliance points are as follows:
- Insurers now insist on baseline photos and measurements to continue NPWT
- Wound VAC claims can be easily denied, audited, or underpaid, particularly in 2016 with the tight 97605/97606 documentation requirements. To ensure your practice gets optimal coding, cleaner claims, and timely payment, consider our help.
- Let our team make sure your wound care claims are coded accurately, well-documented, and audit-proof.
Get Expert Help With NPWT and Wound Care Billing Today
The documentation rules are strict in 2026. Errors in wound VAC billing can lead to denials, audits, and lost revenue. Professional help makes a big difference if your practice wants accurate coding, cleaner claims, and fewer delays in getting paid.
Let our billing experts make sure that your wound care claims are properly coded, fully documented, and ready for an audit from the very beginning.
Frequently Asked Questions
1. What documentation is needed for NPWT billing?
Wound measurements, device type, pressure settings, exudate description, medical necessity, and clear provider documentation of a complete NPWT session are required for compliant billing.
2. Can NPWT be billed for closed surgical incisions?
No, NPWT over closed surgical incisions is generally not separately billable unless there is a documented open wound or specific medical necessity supporting its use.
3. Is NPWT covered during the global surgical period?
Yes, NPWT may be covered during a global period only if the treated wound is unrelated to the surgery and properly documented with appropriate modifiers.
4. How often can CPT 97605 be billed?
CPT 97605 can typically be billed once per day when a complete NPWT session is performed and fully documented with wound assessment and treatment details.
5. Are photos required for wound VAC reimbursement?
Many payers now require baseline and follow-up wound photographs along with measurements to support medical necessity and justify ongoing negative pressure wound therapy authorization.
