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Negative Pressure Wound Therapy

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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,
    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.

 

Last Updated Wed, 18 May 2022 20:22:25 +0000

The below are topic specific articles which have been published to "Latest Updates" and sent out in Noridian emails within the past two years. Exclusions to this include time sensitive related announcements such as: Noridian and CMS educational events, Ask-the-Contractor Teleconferences and claims processing downtime.

paginationType noridian
Negative Pressure Wound Therapy (NPWT) Continued Coverage 05/19/2022
Negative Pressure Wound Therapy (NPWT) 05/12/2022
Policy Article Revisions Summary for July 8, 2021 07/08/2021