A Negative Pressure Wound Therapy pump (E2402) and supplies (A6550, A7000) are covered when either criterion A or B is met:
Ulcers and Wounds in the Home Setting:
The beneficiary has a chronic Stage 3 or 4 pressure ulcer, neuropathic (for example, diabetic) ulcer, venous or arterial insufficiency ulcer, or a chronic (being present for at least 30 days) ulcer of mixed etiology. A complete wound therapy program described by criterion 1 and criteria 2, 3, or 4, as applicable depending on the type of wound, must have been tried or considered and ruled out prior to application of NPWT.
For all ulcers or wounds, the following components of a wound therapy program must include a minimum of all of the following general measures, which should either be addressed, applied, or considered and ruled out prior to application of NPWT:
Documentation in the beneficiary's medical record of evaluation, care, and wound measurements by a licensed medical professional, and
Application of dressings to maintain a moist wound environment, and
Debridement of necrotic tissue if present, and
Evaluation of and provision for adequate nutritional status
For Stage 3 or 4 pressure ulcers:
The beneficiary has been appropriately turned and positioned, and
The beneficiary has used a group 2 or 3 support surface for pressure ulcers on the posterior trunk or pelvis, and
The beneficiary’s moisture and incontinence have been appropriately managed
For neuropathic (for example, diabetic) ulcers:
The beneficiary has been on a comprehensive diabetic management program, and
Reduction in pressure on a foot ulcer has been accomplished with appropriate modalities
For venous insufficiency ulcers:
Compression bandages and/or garments have been consistently applied, and
Leg elevation and ambulation have been encouraged
Ulcers and Wounds Encountered in an Inpatient Setting:
An ulcer or wound is encountered in the inpatient setting and, after wound treatments described under A-1 through A-4 have been tried or considered and ruled out, NPWT is initiated because it is considered in the judgment of the treating practitioner, the best available treatment option.
The beneficiary has complications of a surgically created wound (for example, dehiscence) or a traumatic wound (for example, pre-operative flap or graft) where there is documentation of the medical necessity for accelerated formation of granulation tissue which cannot be achieved by other available topical wound treatments (for example, other conditions of the beneficiary that will not allow for healing times achievable with other topical wound treatments).
In either situation B-1 or B-2, NPWT will be covered when treatment is ordered to continue beyond discharge to the home setting.
For more detailed and up to date information, please refer to the CMS.gov website: