Billing Negative Pressure Wound Therapy (NPWT)
Under the Consolidated Appropriations Act of 2016 (Pub. L 114-113) a separate payment is made to home health agencies (HHAs) for disposable NPWT devices when furnished on or after January 1, 2017, to a beneficiary receiving home health services under the Medicare home health prospective payment system (HH PPS).
- When the entire visit provides services associated with furnishing NPWT using a disposable device, the visit is reported on a 34X type of bill (TOB). This visit would not be reported on the HH PPS claim, 32X TOB.
Example: A nurse assesses the patient's condition, assesses the wound, and applies a new disposable NPWT device. The nurse also provides wound care education to the patient and family. On the following Monday, the nurse returns, assesses the wound, and replaces the device that was applied the week before with an entirely new disposable NPWT device.
Billing Procedure: All services provided were associated with furnishing NPWT using a disposable device. The nurse did not provide any services other than furnishing a NPWT using a disposable device. Therefore, all nursing services for both visits would be reported on TOB 34X claim with CPT® code 97607 or 97608. None of the services should be reported on TOB 32X.
- When home health visits include home health services in addition to, and separate from furnishing NPWT using a disposable device, the HHA will submit a 34X TOB to capture the services associated with furnishing NPWT using a disposable device, and a 32X TOB for the services associated with other home health services.
Example: On Monday, the nurse applies a new disposable NPWT device, and provides instructions for ongoing wound care. During this same visit, per the HH plan of care, the nurse changes the indwelling catheter and provides troubleshooting information and teaching regarding its maintenance.
Billing Procedure: The visit included applying a new disposable NPWT device as well as services unrelated to that NPWT service, which means the HHA will submit both a TOB 34X and a TOB 32X claim.
The claim for TOB 34X with CPT® code 97607 or 97608 would be submitted for the application of the new disposable NPWT device and the time spent instructing the patient about ongoing wound care.
The TOB 32X would be submitted for services not associated with furnishing NPWT using a disposable device (i.e., replacement of the indwelling catheter and troubleshooting and maintenance).
Example: On Monday, the nurse applies a new disposable NPWT device. On Thursday, the nurse the nurse returns for a scheduled visit to change the patient's indwelling catheter. While there, the nurse assesses the wound and applies a new fluid management system (or dressing) for the existing disposable NPWT device, but does not replace the device entirely.
Billing Procedure: For the Monday visit, all the nursing services were associated with furnishing NPWT using a disposable device. The nurse did not provide any services that were not associated with furnishing NPWT using a disposable device. Therefore, the nursing visit should be reported on the claim with TOB 34X with CPT® code 97607 or 97608; the visit should not be reported on a 32X claim.
For the Thursday visit, while the nursing services included wound assessment and application of a component of the disposable NPWT device, the nurse did not furnish a new disposable NPWT device. Therefore, all nursing services for the visit, including the catheter changes and wound care should be reported on the claim with TOB 32X.
- When 97607 and 97608 are reported on the 34X TOB and the NPWT service falls within a HH PPS episode, payment is made under the Medicare Hospital Outpatient Prospective Payment System (OPPS).
- If the NPWT service is not within a HH PPS episode, the 042x and 043x services are paid under the Medicare Physicians Fee Schedule (MPFS), and the NPWT revenue code 0559 (CPT® 97607 or 97608) will be denied
In addition to the usual information that is required on Medicare claims, the following identifies specific information required for HHAs to submit NPWT on a 34X type of bill (TOB).
Field Name |
Description |
|---|---|
TOB |
34X – Performing NPWT using a disposable device (integrated system of a vacuum pump, receptacle for collecting exudate, and dressings for the purpose of wound therapy). |
STMT DATES FROM/TO |
Enter the dates of service for the billing period. NOTE: the dates should fall within the "FROM" and "TO" dates for the HH PPS episode of care provided by the primary HHA. |
REV |
Report the appropriate revenue code. Valid codes are: |
HCPC |
Enter the appropriate CPT® code (report with revenue code 0559): 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. |
TOT UNIT/COV UNIT |
Report 1. |
TOT CHARGES |
Enter the total charge for all revenue codes. |
SERV DATE |
Enter the date the service was provided. |
REMARKS |
Enter NPWT |
Additional Resources
- MLN Matters® article, SE17027
, Clarification of Billing and Payment Policies for Negative Pressure Wound Therapy (NPWT) Using a Disposable Device - MLN Matters® article, MM9898, Manual Updates to Clarify Payment Policy Changes for Negative Pressure Wound Therapy (NPWT) Using a Disposable Device and the Outlier Payment Methodology for Home Health Services
- MLN Matters® article, MM9736, Implementation of Policy Changes for the CY 2017 Home Health Prospective Payment System
- Medicare Claims Processing Manual, Pub 100-04, Chapter 10, Section 90.3
Updated: 06.18.19
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