Negative Pressure Wound Therapy (NPWT)

Negative-pressure wound therapy (NPWT) is a therapeutic technique using a vacuum dressing to promote healing in acute or chronic wounds and enhance healing of first and second degree burns. The therapy involves the controlled application of sub-atmospheric pressure to the local wound environment,using a sealed wound dressing connected to a vacuum pump.

Medicare Information and Qualifications:

A Negative Pressure Wound Therapy pump and supplies are covered by Medicare when either criterion A or B is met:

A) Ulcers and Wounds in the Home Setting:

The beneficiary has a chronic Stage III or IV 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.

1. 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.

2. For Stage III or IV 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 (see LCDs on support surfaces),
  • The beneficiary’s moisture and incontinence have been appropriately managed.

3. 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.

4. For venous insufficiency ulcers:

  • Compression bandages and/or garments have been consistently applied, and
  • Leg elevation and ambulation have been encouraged.

B) Ulcers and Wounds Encountered in an Inpatient Setting:

1. An ulcer or wound (described under A above) 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 physician, the best available treatment option.

2. The beneficiary has complications of a surgically created wound or a traumatic wound 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.

If criterion A or B above is not met, the NPWT pump and supplies will be denied as not reasonable and necessary.