How much does Medicare pay for CPT 97606?

Medicare allowed an average of $30.65 per service and paid $24.38 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $193.39, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 97606?

Therapy procedure using a special bandage and vacuum pump, surface area more than 50.0 sq cm. It was billed 1,396 times to 812 Medicare beneficiaries by 50 providers in 2024.

Does 97606 pay differently in an office than a hospital?

Yes. The allowed amount averaged $56.41 in an office setting and $25.99 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 97606 most?

General Surgery, with 583 services from 19 clinicians. Next are Plastic and Reconstructive Surgery, Orthopedic Surgery, Thoracic Surgery.

CPT 97606

Therapy procedure using a special bandage and vacuum pump, surface area more than 50.0 sq cm

$30.65Medicare-allowed amount per service, averaged across 1,396 services

Providers submitted

$193.39

Asking price, not received

Medicare allowed

$30.65

The fee schedule figure

Medicare paid

$24.38

Balance is patient coinsurance

Providers submitted an average of $193.39 for this code and Medicare allowed $30.65 — 6.3× 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 $24.38 (80%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $56.41
Hospital / facility: $25.99

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. 214 services were billed in an office setting and 1,182 in a facility.

Services: 1,396
Beneficiaries: 812
Providers billing it: 50
Total allowed: $42,787

What Medicare pays for CPT 97606

Across 1,396 services billed by 50 providers to 812 beneficiaries, Medicare allowed an average of $30.65 per service. That is 1.7 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 97606

Specialty	Services	Beneficiaries	Avg allowed	Providers
General Surgery	583	282	$37.13	19
Plastic and Reconstructive Surgery	316	222	$27.40	13
Orthopedic Surgery	115	109	$26.63	5
Thoracic Surgery	84	34	$25.24	2
Nurse Practitioner	73	24	$22.57	2
Physician Assistant	69	20	$21.77	1
Critical Care (Intensivists)	63	44	$25.86	2
Surgical Oncology	43	39	$25.48	3
Podiatry	39	27	$28.58	2
Colorectal Surgery (Proctology)	11	11	$28.13	1

97606 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
Florida	425	$24.99	$19.85	13
New Jersey	214	$56.41	$39.25	1
District of Columbia	138	$29.17	$20.56	6
New York	93	$28.60	$20.54	4
California	77	$27.51	$20.32	4
Michigan	75	$23.57	$18.31	2
Georgia	55	$25.76	$20.58	3
Texas	50	$24.08	$18.98	3
Colorado	46	$26.31	$20.56	2
Arizona	41	$25.46	$20.56	1
Oklahoma	37	$25.18	$20.56	3
South Carolina	31	$22.71	$20.90	2
Kentucky	27	$26.09	$20.76	1
Maryland	26	$29.99	$20.59	1
Louisiana	23	$25.23	$20.59	1
Arkansas	15	$23.72	$20.87	1
Missouri	12	$25.13	$20.59	1
Illinois	11	$26.57	$20.53	1

Related codes

97610Therapy procedure$406.92
97605Therapy procedure$24.49
97607Therapy procedure$203.89

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.