Negative Pressure Wound Therapy - JA DME
Negative Pressure Wound Therapy
Coverage
- Negative Pressure Wound Therapy Pumps Local Coverage Determination (LCD)
- Negative Pressure Wound Therapy Pumps Policy Article
Documentation
- Standard Documentation Requirements for All Claims Submitted to DME MACs
- Clinician Checklist Negative Pressure Wound Therapy - Continuous Coverage - Checklist to assist clinicians with coverage and documentation requirements
- Clinician Checklist Negative Pressure Wound Therapy - Home Setting - Checklist to assist clinicians with coverage and documentation requirements
- Clinician Checklist Negative Pressure Wound Therapy - Inpatient Setting - Checklist to assist clinicians with coverage and documentation requirements
- Clinician Letter - Medical Records - Letter may be sent to clinicians to help obtain documentation
- Clinician Letter - Negative Pressure Wound Therapy (NPWT) Pump - Letter may be sent to clinicians to help obtain documentation
- Negative Pressure Wound Therapy Documentation Checklist - Checklist to ensure suppliers gather all required documentation
Reviews/Audits
- Medical Review - View notifications/findings of pre/post claim reviews completed by Noridian Medical Review
Tips
Billing Exclusions
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.
Negative Pressure Wound Therapy (NPWT) Continued Coverage
For qualifying wounds coverage to continue, a licensed medical professional must do the following:
- On a regular basis,
- Directly assess the wound(s) being treated with the NPWT pump, and
- 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.
Last Updated Mar 12 , 2025
