How much does Medicare pay for CPT 97607?

Medicare allowed an average of $203.89 per service and paid $163.07 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $766.31, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 97607?

Therapy procedure using a special bandage, vacuum pump and disposable medical equipment, surface area 50.0 sq cm or less. It was billed 4,224 times to 1,945 Medicare beneficiaries by 76 providers in 2024.

Does 97607 pay differently in an office than a hospital?

Yes. The allowed amount averaged $326.97 in an office setting and $21.15 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 97607 most?

Family Practice, with 1,672 services from 7 clinicians. Next are Orthopedic Surgery, General Surgery, Thoracic Surgery.

CPT 97607

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

$203.89Medicare-allowed amount per service, averaged across 4,224 services

Providers submitted

$766.31

Asking price, not received

Medicare allowed

$203.89

The fee schedule figure

Medicare paid

$163.07

Balance is patient coinsurance

Providers submitted an average of $766.31 for this code and Medicare allowed $203.89 — 3.8× 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 $163.07 (80%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $326.97
Hospital / facility: $21.15

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. 2,524 services were billed in an office setting and 1,700 in a facility.

Services: 4,224
Beneficiaries: 1,945
Providers billing it: 76
Total allowed: $861,231

What Medicare pays for CPT 97607

Across 4,224 services billed by 76 providers to 1,945 beneficiaries, Medicare allowed an average of $203.89 per service. That is 2.2 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 97607

Specialty	Services	Beneficiaries	Avg allowed	Providers
Family Practice	1,672	273	$315.43	7
Orthopedic Surgery	1,350	1,273	$21.39	45
General Surgery	784	124	$319.54	6
Thoracic Surgery	88	85	$20.18	4
Infectious Disease	51	13	$20.21	1
Physical Therapist in Private Practice	45	13	$340.72	1
Nurse Practitioner	37	24	$19.59	2
General Practice	34	12	$371.67	1
Internal Medicine	34	12	$331.89	1
Plastic and Reconstructive Surgery	32	32	$19.74	2
Emergency Medicine	27	14	$358.30	1
Cardiac Surgery	24	24	$19.08	2
Sports Medicine	18	18	$19.94	1
Vascular Surgery	17	17	$19.03	1
Neurosurgery	11	11	$19.20	1

97607 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	1,629	$288.18	$238.76	10
Texas	1,042	$198.85	$158.53	17
Georgia	212	$268.14	$240.05	3
Illinois	185	$228.29	$195.94	3
New York	184	$24.20	$16.41	5
New Jersey	147	$21.74	$16.41	4
Massachusetts	132	$20.80	$16.38	4
California	103	$269.11	$192.37	3
Ohio	72	$19.76	$16.40	2
Pennsylvania	54	$21.95	$16.39	1
Wisconsin	50	$19.10	$16.42	4
North Carolina	47	$19.82	$16.16	3
Wyoming	45	$340.72	$268.38	1
Connecticut	34	$371.67	$271.93	1
Oregon	34	$21.52	$16.38	2
Tennessee	33	$19.12	$16.38	1
Indiana	30	$19.18	$16.41	1
Kentucky	28	$20.27	$16.38	2
South Carolina	27	$19.83	$16.42	2
Nebraska	27	$358.30	$271.90	1
Kansas	19	$16.32	$13.97	1
New Hampshire	19	$20.61	$16.39	1
Louisiana	18	$19.94	$16.42	1
Alaska	18	$23.04	$11.62	1
Virginia	18	$20.09	$16.39	1
District of Columbia	17	$22.74	$16.45	1

Related codes

97610Therapy procedure$406.92
97605Therapy procedure$24.49
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.