Negative Pressure Wound Therapy - JA DME

A NPWT pump and supplies will be denied as not reasonable and necessary if one or more of the following are present:

• The presence in the wound of necrotic tissue with eschar if debridement has not been attempted.
• Osteomyelitis within the vicinity of the wound that is not concurrently being treated with intent to cure.
• Cancer present in the wound.
• The presence of an open fistula to an organ or body cavity within the vicinity of the wound.

For qualifying wounds coverage to continue, a licensed medical professional must do the following:

• On a regular basis,
  1. Directly assess the wound(s) being treated with the NPWT pump, and
  2. Supervise or directly perform the NPWT dressing changes, and
• On at least a monthly basis, document changes in the ulcer's dimensions and characteristics.

If this criterion is not fulfilled, continued coverage of the NPWT pump and supplies will be denied as not reasonable and necessary.