Home Health Billing

Disposable Negative Pressure Wound Therapy Services Under Home Health

Effective for services furnished on or after 1/1/2017, Medicare will make separate payment to HHAs for dNPWT services for patients under the home health benefit.

NPWT using a disposable device is an integrated system comprised of a non-manual vacuum pump, a receptacle for collecting exudate, and dressings for the purposes of wound therapy (in lieu of a conventional dNPWT DME system). NPWT using a disposable device is excluded from the HH PPS rate, but must be billed by the HHA while a patient is under a home health plan of care since the law requires consolidated billing of dNPWT service.

Since dNPWT is considered part of consolidated billing, the consolidated billing rules apply. Effective for period of care claims with through dates prior to 1/1/2024, dNPWT is billed outside of the HH PPS claim on the 34x TOB. Payment for dNPWT is equal to the amount of the payment that would otherwise be made under the OPPS.

Billing dNPWT Provided to a Home Health Patient - Services Prior to 1/1/2024

Disposable NPWT services are billed using the following CPT codes:

  • 97607 – Negative pressure wound therapy, (e.g., vacuum assisted drainage collection), utilizing disposable, nondurable 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.

These CPT codes include payment for both performing the service and the dNPWT device. Services related to furnishing dNPWT that do not encompass the placement or replacement of the entire integrated system should be billed per existing HH PPS guidelines. Any follow-up visits for wound assessment, wound management, and dressing changes where a new dNPWT device is not applied must be included on the home health episode claim (TOB 32x).

The HHA reports the CPT code with one of three revenue codes, depending on the practitioner that provided the service:

  • Skilled nurse – 0559
  • Physical therapist – 042x
  • Occupational therapy – 043x

To avoid duplication of payment, for instances where the sole purpose for an HHA visit is to perform dNPWT, Medicare will not pay for a skilled nursing or therapy visit under HH PPS. Rather, when furnishing dNPWT, the device and services associated with furnishing the device are paid separately based on the OPPS amount. In this situation, the HHA bills only under TOB 34x. This visit is not reported on the HH PPS claim (TOB 32x).

If dNPWT is performed during the course of an otherwise covered home health visit (e.g., to perform a catheter change), the visit would be covered as normal. Performing dNPWT will be separately reimbursed based on the OPPS amount assigned to 97607 and 97608. In this situation, the HHA bills under TOB 34x and this visit is also reported on the HH PPS claim (TOB 32x). The HHA must not include the time spent performing dNPWT in their visit charge or in the length of time reported for the visit on the HH PPS claim.

Example: During a regularly scheduled home health visit, a nurse changes the patient’s catheter. In the course of the same visit, the nurse applies a new dNPWT device and instructs about wound care. In this case the HHA will bill a 34x TOB for the NPWT services and include the nursing services unrelated to the NPWT on the HH PPS 32x claim. It is appropriate to bill two separate claims in this example. The nursing services not related to NPWT treatment should be included on the 32x HH PPS claim; the nursing services for NPWT care should be billed on a 34x claim.

Billing dNPWT Provided to a Home Health Patient – Services With Through Dates on or after 1/1/2024

Effective for period of care claims with through dates on or after 1/1/2024, any dNPWT services provided to the home health patient should be included on the period of care claims (TOB 32x). The line item for dNPWT should be billed with the appropriate revenue code and HCPCS A9272. The line-item billing requirements under HH PPS also apply to dNPWT; in addition to the revenue code and HCPCS, the HHA should also report the date of service, units, and total charges. MACs will apply deductible and coinsurance to HCPCS code A9272 on TOB 032x.

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Revised 12/11/2023