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Issue Number - Name
0017 - Negative Pressure Wound Therapy
Review Type
Complex
Claim Type
DME Supplier
Region and State
RAC 5
All States
Date Approved
2017-04-26

Description

Medical necessity and coding review: Documentation will be reviewed to determine if the use of negative pressure wound therapy meets Medicare coverage criteria.

Affected Codes

  • E2402, A6550, A7000

Applicable Policy References

  • Title XVIII of the Social Security Act, Section 1862(a)(1)(A)
  • Title XVIII of the Social Security Act, Section 1833(e)
  • CMS Pub. 100-02, Medicare Benefit Policy Manual, Chapter 15, Section 110 
  • CMS Pub. 100-04, Medicare Claims Processing Manual, Chapter 34, Section 10.6.1 and 10.6.2 
  • CMS Pub. 100-08, Medicare Program Integrity Manual, Chapter 5, Section 5.7, 5.8 and 5.9 
  • CMS Pub. 100-08, Medicare Program Integrity Manual, Chapter 3, Section 3.3.2, 3.3.2.4 and 3.4.1.1 
  • Local Coverage Determination, L33821, Effective 10/01/2015
  • MAC Policy Article, A52511, Effective 10/01/2015
  • Local Coverage Determinations L11500, L5008, L27025, and L11489 – Negative Pressure Wound Therapy Pumps, Effective 10/1/2000, Retired 9/30/2015
  • MAC Policy Articles, A35347, A35363, A47111, and A35425, Effective 10/1/2005 Retired 9/30/2015
  • CMS Policy Article, A55426, Effective 1/1/2017 

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