Hospitals (Inpatient) coding, Medicare payment and coverage information
Calendar Year (CY) 2018 Medicare Severity-Diagnosis Related Groups (MS-DRG) Payment System
Medicare does not separately reimburse hospitals for the PICO Single Use Negative Pressure Wound Therapy System when it is furnished to patients in the inpatient setting. Payment for the PICO Single Use Negative Pressure Wound Therapy System is included in the MS-DRG payment.
Payment rates from non-Medicare payers will depend on each hospital’s contract with each payer. Ensure that reported charges associated with CPT® codes 97607 and 97608 reflect the cost of the PICO Single Use Negative Pressure Wound Therapy System, as well as, the work to assess the wound, apply it, and provide instructions for ongoing care. Unlike CPT® codes 97605 and 97606 that describe traditional negative pressure wound therapy using durable medical equipment that is billed separately from the procedure;
CPT® codes 97607 and 97608 include the cost of the disposable negative pressure wound therapy device. Hospitals may want to contemplate these differences when setting charges.
Before applying PICO Single Use Negative Pressure Wound Therapy System, all hospitals should confirm or clarify coverage and coding from each patient’s insurance plan, as each payer may have differing formal or informal policies or decisions. For assistance with insurance benefit verification, call 1-888-705-0061 Monday through Friday 8:00 am to 5:00 pm EST.
For detailed product information, including indications for use, contraindications, effects, precautions and warnings, please consult the product’s Instructions for Use (IFU) prior to use.