Billing Instructions for Disposable Negative Pressure Wound

90.3 – Billing Instructions for Disposable Negative Pressure Wound 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.