Hospitals (Inpatient)

Hospitals (Inpatient) coding, Medicare payment and coverage information

Calendar Year (CY) 2017 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.

NOTE:

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.

Coverage

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.

Click on this link to download a copy of the hospital inpatient coding, Medicare payment, and coverage information.

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.

CPT® is a registered trademark of the American Medical Association
Smith & Nephew, Inc. provides this content for informational purposes only. The information contained herein is gathered from various sources on November 15, 2016 and is subject to change without notice. Smith & Nephew, Inc. cannot guarantee success in obtaining coverage or payment. Reimbursement for medical products and services is affected by numerous factors. It is always the provider’s responsibility to determine and submit appropriate codes, charges, and modifiers for services that are rendered. Actual codes and/or modifiers used are at the sole discretion of the treating physician and/or facility. Providers should contact their third-party payers for specific information on their coding, coverage, and payment policies. This guide is in no way intended to promote the off label use of any product.