Reimbursement overview
The reimbursement helpline provides you with information concerning the coding, payment, and coverage for the application of PICO Single Use Negative Pressure Wound Therapy System and how it may apply to your wound care business.
PICO reimbursement helpline
Call S+N Reimbursement Hotline Services at 1 866-988-3491 Monday through Friday 8:00AM to 7:00PM ET. for help with reimbursement questions. A reimbursement associate can help you with topics such as:
Coding information
- Verifies the appropriate codes required on claims
Tips for payer research
- Provides checklists to help facilitate insurance research. These checklists provide tips for determining coverage, securing prior authorization, determining reason for claim denial or underpayment, and preparing appeals
Sample letters of medical necessity and appeal
- Provides sample letters of medical necessity to help expedite prior authorization and appeals
Insurance benefits verification
- Verifies patients' specific insurance benefits for PICO Single Use Negative Pressure Wound Therapy System
Prior authorization requirements
- Determines prior authorization requirements for physicians or other qualified healthcare professionals (QHPs) to apply PICO on a specific patient
- Advises the QHP of the prior authorization submission steps
CPT® codes
Effective January 1, 2015, CPT® codes, 97607 and 97608 are used to report the application of negative pressure wound therapy (NPWT) using disposable non-durable medical equipment. This includes:
- Provision of exudate management collection system;
- Topical application(s);
- Wound assessment; and
- Instructions for ongoing care
Following are the current CPT® codes with their descriptions:
| CPT® Code | Description |
|---|---|
| 97607 | Negative pressure wound therapy (eg, 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 (eg, 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. |
CPT® is a registered trademark of the American Medical Association.
Payment systems
Because Medicare fee-for-service varies by site of care, the payment section describes how the PICO Single Use Negative Pressure Wound Therapy System fits into the payment systems of: