Initiation of Powered Negative Pressure Wound Therapy
An initial therapeutic trial of not less than 2 weeks using a powered negative pressure wound therapy (NPWT) system, as part of a comprehensive wound care program that includes controlling factors (eg, diabetes, nutrition, relief of pressure), may be considered medically necessary in the following indications:
Chronic (>90 days) stage III or IV pressure ulcers that have failed to heal despite optimal wound care when there is high-volume drainage that interferes with healing and/or when standard dressings cannot be maintained due to anatomic factors; OR
Wounds in patients with underlying clinical conditions that are known to negatively impact wound healing, which are nonhealing (at least 30 days), despite optimal wound care. (Examples of underlying conditions include, but are not limited to diabetes, malnutrition, small vessel disease, and morbid obesity. Malnutrition, while a risk factor, must be addressed simultaneously with the NPWT.); OR
Traumatic or surgical wounds where there has been a failure of immediate or delayed primary closure.
Continuation of Powered NPWT
Continuation of the powered NPWT system, as part of a comprehensive wound care program, may be considered medically necessary following an initial 2-week therapeutic trial if the treatment trial has resulted in documented objective improvements in the wound, and if there is an ongoing objective improvement during subsequent treatment. Objective improvements in the wound should include the development and presence of healthy granulation tissue, progressive wound contracture and decreasing depth, and/or the commencement of epithelial spread from the wound margins.
Continuation of the powered NPWT system is considered investigational when any of the following occurs:
The therapeutic trial or subsequent treatment period has not resulted in documented objective improvement in the wound, OR
The wound has developed evidence of wound complications contraindicating continued NPWT, OR
The wound has healed to the extent that either grafting can be performed or the wound can be anticipated to heal completely with other wound care treatments.
Therapeutic trials of powered NPWT systems for the treatment of other acute or chronic wounds except as noted above are considered investigational.
Use of single-use NPWT systems (powered or nonpowered)is considered investigational for the treatment of acute or chronic wounds, including but not limited to diabetic, venous, surgical, and traumatic wounds.