How much does Medicare pay for CPT 97605?

Medicare allowed an average of $24.49 per service and paid $19.39 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $142.26, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 97605?

Therapy procedure using a special bandage and vacuum pump, surface area 50.0 sq cm or less. It was billed 4,966 times to 3,165 Medicare beneficiaries by 156 providers in 2024.

Does 97605 pay differently in an office than a hospital?

Yes. The allowed amount averaged $31.63 in an office setting and $23.39 in a facility. The office rate is generally higher because the practice supplies the room, staff and equipment out of that single payment; in a hospital those are billed separately by the facility.

Which specialty bills 97605 most?

Orthopedic Surgery, with 1,751 services from 58 clinicians. Next are Nurse Practitioner, General Surgery, Emergency Medicine.

CPT 97605

Therapy procedure using a special bandage and vacuum pump, surface area 50.0 sq cm or less

$24.49Medicare-allowed amount per service, averaged across 4,966 services

Providers submitted

$142.26

Asking price, not received

Medicare allowed

$24.49

The fee schedule figure

Medicare paid

$19.39

Balance is patient coinsurance

Providers submitted an average of $142.26 for this code and Medicare allowed $24.49 — 5.8× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $19.39 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $31.63
Hospital / facility: $23.39

The office rate is higher because the practice supplies the room, staff and equipment out of that payment. In a hospital the facility bills those separately, so the clinician's share is smaller — the total cost to Medicare is usually higher, not lower. 665 services were billed in an office setting and 4,301 in a facility.

Services: 4,966
Beneficiaries: 3,165
Providers billing it: 156
Total allowed: $121,617

What Medicare pays for CPT 97605

Across 4,966 services billed by 156 providers to 3,165 beneficiaries, Medicare allowed an average of $24.49 per service. That is 1.6 services per beneficiary, so this is a code patients typically receive more than once. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 97605

Specialty	Services	Beneficiaries	Avg allowed	Providers
Orthopedic Surgery	1,751	1,634	$23.97	58
Nurse Practitioner	620	271	$20.69	20
General Surgery	391	288	$26.37	20
Emergency Medicine	335	99	$23.01	6
Podiatry	326	144	$24.62	10
Plastic and Reconstructive Surgery	276	159	$25.32	7
Physician Assistant	244	103	$19.35	6
Family Practice	230	85	$25.32	6
Internal Medicine	177	48	$24.13	3
Thoracic Surgery	108	64	$23.25	4
Vascular Surgery	94	54	$25.37	4
Pediatric Medicine	89	21	$36.77	1
Colorectal Surgery (Proctology)	67	55	$25.50	2
Infectious Disease	58	12	$40.85	1
Diagnostic Radiology	49	28	$47.55	1

97605 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
Texas	793	$22.89	$18.37	21
Florida	709	$24.24	$19.39	21
California	497	$27.91	$20.20	9
New York	493	$25.10	$18.10	17
New Jersey	398	$23.62	$17.12	7
Georgia	223	$23.03	$19.41	10
Idaho	161	$21.87	$17.86	3
Illinois	157	$21.50	$17.07	7
District of Columbia	156	$26.54	$18.63	5
Arizona	142	$26.25	$20.78	4
Kansas	139	$30.55	$26.68	2
Ohio	112	$23.18	$18.62	6
Michigan	84	$22.41	$17.12	2
Tennessee	77	$20.66	$17.58	5
Wisconsin	75	$21.68	$18.29	4
South Dakota	60	$19.78	$15.64	1
Maryland	49	$24.67	$18.71	3
Virginia	48	$24.52	$18.71	3
Nevada	47	$23.44	$18.71	1
Kentucky	46	$22.89	$18.70	1
Wyoming	43	$42.06	$32.80	1
Arkansas	42	$23.25	$33.59	1
Pennsylvania	40	$24.53	$18.76	3
Alabama	39	$32.73	$27.96	1
West Virginia	37	$22.73	$18.98	2
North Carolina	36	$23.35	$18.86	1
Nebraska	35	$19.45	$15.51	2
South Carolina	31	$22.98	$18.71	2
New Hampshire	31	$22.87	$18.88	2
Delaware	27	$20.13	$15.39	1
Indiana	25	$22.96	$18.74	1
Massachusetts	23	$47.48	$33.52	1
Colorado	16	$24.15	$18.67	1
Rhode Island	16	$21.12	$19.33	1
Washington	16	$22.85	$15.93	1
New Mexico	15	$23.18	$18.72	1
Missouri	14	$19.44	$15.93	1
Louisiana	14	$22.93	$18.76	1

Related codes

97610Therapy procedure$406.92
97607Therapy procedure$203.89
97606Therapy procedure$30.65

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.