Negative Pressure Wound Therapy Pumps Policy Specific Requirements

The beneficiary's medical records must contain information regarding the history, prior treatment plans (if applicable), and current wound care for which a Negative Pressure Wound Therapy (NPWT) pump is being billed. The records have to contain:

  • Time NPWT pump was in use
  • Dressing types and frequency of change, and
  • Changes in wound conditions, including
    • Precise measurements,
    • Quantity of exudates,
    • Presence of granulation and necrotic tissue, and
    • Concurrent measures being addressed relevant to wound therapy
      • Debridement
      • Nutritional concerns
      • Support surfaces in use
      • Positioning
      • Incontinence control

Information describing the wound evaluation and treatment that is recorded in the beneficiary's medical record must be used to demonstrate the regular evaluation and treatment of the beneficiary’s wounds. Comparing the size of wounds month to month requires comparing areas with similar measurements. The supplier of the equipment and supplies must obtain from the treating clinician an assessment of wound healing progress based upon the wound measurement as documented in the beneficiary's medical record in order to determine whether the NPWT equipment and supplies still qualify for Medicare coverage.

Documentation of quantitative measurements of wound characteristics including:

  • Wound length and width (surface area), and depth, and
  • Amount of wound exudate (drainage),
  • Indicating progress of healing must be entered at least monthly.

Additional information on Negative Pressure Would Therapy Pumps can be found in the Local Coverage Determination (LCD) L33821 and Policy Article A52511 on the CMS website.

Last Updated Feb 23 , 2024