97597 Dbrdmt opn wnd 1st 20 cm/<
What 97597 is
CMS fee schedule short descriptor: Dbrdmt opn wnd 1st 20 cm/<.
Full CPT long descriptions are licensed by the American Medical Association and are not published on this site; the short descriptor above is the one CMS prints in its own fee schedule file. See About CPT.
Medicare payment for 97597 (CY2026)
| Work RVU | Practice expense RVU | Malpractice RVU | Total | Medicare rate | |
|---|---|---|---|---|---|
| Non-facility (office) | 0.75 | 2.24 | 0.05 | 3.04 | $101.54 |
| Facility (hospital, ASC) | 0.75 | 0.13 | 0.05 | 0.93 | $31.06 |
National rates: total RVUs x the CY2026 conversion factor of 33.4009 (non-QP), before geographic adjustment. Actual Medicare payment is 80% of the rate shown after the deductible; the patient or secondary payer owes the 20% coinsurance.
Status: Active - payable under the Physician Fee Schedule. Global period: Global concept does not apply (endoscopic or minor procedure: global period is the day of the procedure).
Medically Unlikely Edit (MUE)
Medicare caps 97597 at 1 unit per date of service for practitioner claims (MAI 3 - date of service edit (clinical): units above the MUE may pay with documentation on appeal), rationale: Nature of Service/Procedure. Units above the cap are denied unless the edit's adjudication rules allow an appeal with documentation.
Billed with 97597? These codes are bundled into it
97597 is a Column 1 code in 494 active NCCI PTP edits. When one of these Column 2 codes is reported on the same date of service, it is denied as bundled - unless the edit's modifier indicator is 1 and documentation supports a distinct service with an NCCI-associated modifier.
| Column 2 code | Short description | Modifier indicator | |
|---|---|---|---|
00100 | Anes px salivary gland w/bx | 0 - no modifier bypass | Check pair |
00102 | Anes px plstc rpr cleft lip | 0 - no modifier bypass | Check pair |
00103 | Anes rcnstv px eyelid | 0 - no modifier bypass | Check pair |
00104 | Anes electroconvulsive ther | 0 - no modifier bypass | Check pair |
00120 | Anes px ear w/bx nos | 0 - no modifier bypass | Check pair |
00124 | Anes px ear otoscopy | 0 - no modifier bypass | Check pair |
00126 | Anes px ear tympanotomy | 0 - no modifier bypass | Check pair |
00140 | Anes procedures on eye nos | 0 - no modifier bypass | Check pair |
00142 | Anes px on eye lens surgery | 0 - no modifier bypass | Check pair |
00144 | Anes px eye corneal trnspl | 0 - no modifier bypass | Check pair |
00145 | Anes px eye vitreortnl surg | 0 - no modifier bypass | Check pair |
00147 | Anes px on eye iridectomy | 0 - no modifier bypass | Check pair |
00148 | Anes px eye ophthalmoscopy | 0 - no modifier bypass | Check pair |
00160 | Anes px nose&sinus nos | 0 - no modifier bypass | Check pair |
00162 | Anes px nose&sinus rad surg | 0 - no modifier bypass | Check pair |
00164 | Anes px nose&sins bx sft tis | 0 - no modifier bypass | Check pair |
00170 | Anes intraoral px nos | 0 - no modifier bypass | Check pair |
00172 | Anes ntroral px rpr clft pal | 0 - no modifier bypass | Check pair |
00174 | Anes ntrorl exc rtrphrng tum | 0 - no modifier bypass | Check pair |
00176 | Anes intraoral px rad surg | 0 - no modifier bypass | Check pair |
00190 | Anes px facial b1/skull nos | 0 - no modifier bypass | Check pair |
00192 | Anes px fcl b1/skl rad surg | 0 - no modifier bypass | Check pair |
00210 | Anes intracranial px nos | 0 - no modifier bypass | Check pair |
00211 | Anes icr px crnec/crnot hmtm | 0 - no modifier bypass | Check pair |
00212 | Anes icr px subdural taps | 0 - no modifier bypass | Check pair |
00214 | Anes icr px burr holes | 0 - no modifier bypass | Check pair |
00215 | Anes icr px crnop/elvtn fx | 0 - no modifier bypass | Check pair |
00216 | Anes icr px vascular px | 0 - no modifier bypass | Check pair |
00218 | Anes icr px in sitting pos | 0 - no modifier bypass | Check pair |
00220 | Anes icr px csf shunting px | 0 - no modifier bypass | Check pair |
Showing 30 of 494 column 2 codes. Use the pair checker for any specific combination.
97597 is bundled into these codes
97597 appears as a Column 2 code in 3558 active edits. Reported with one of these Column 1 codes on the same date of service, 97597 is the code that denies.
| Column 1 code | Short description | Modifier indicator | |
|---|---|---|---|
0100T | Prosth retina receive&gen | 1 | Check pair |
0164T | Remove lumb artif disc addl | 1 | Check pair |
0165T | Revise lumb artif disc addl | 1 | Check pair |
0184T | Exc rectal tumor endoscopic | 1 | Check pair |
0200T | Perq sacral augmt unilat inj | 1 | Check pair |
0201T | Perq sacral augmt bilat inj | 1 | Check pair |
0202T | Post vert arthrplst 1 lumbar | 1 | Check pair |
0234T | Trluml perip athrc renal art | 1 | Check pair |
0235T | Trluml perip athrc visceral | 1 | Check pair |
0236T | Trluml perip athrc abd aorta | 1 | Check pair |
0237T | Trluml perip athrc brchiocph | 1 | Check pair |
0238T | Trluml perip athrc iliac art | 1 | Check pair |
0253T | Insert aqueous drain device | 1 | Check pair |
0308T | Insj ocular telescope prosth | 1 | Check pair |
0402T | Colgn crs-link crn&pachymtry | 1 | Check pair |
Data: CMS CY2026 Physician Fee Schedule RVU file (October release, RVU26D) and Medicare NCCI PTP practitioner edits v32.3 (2026 Q4). Verify against the official files before billing or contracting decisions.