Does E2402 require prior authorization?

No, E2402 does not require prior authorization (high confidence). Code is covered without prior authorization.

`E2402` — Negative pressure wound therapy electrical pump, stationary or portable

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

A Standard Written Order (SWO) or, where applicable, a signed Written Order Prior to Delivery (WOPD) must be received by the supplier before a claim is submitted or the DMEPOS base item is delivered.
Medical record must document wound evaluation, care, and measurements by a licensed medical professional prior to and during NPWT.
Medical record must document application of moist dressings, debridement when indicated, and evaluation/provision of adequate nutrition prior to NPWT.
For Stage 3/4 pressure ulcers document turning/positioning, use of group 2 or 3 support surface for posterior trunk/pelvis, and moisture/incontinence management prior to NPWT.

For Stage 3 or 4 pressure ulcers, beneficiary must have been appropriately turned and positioned prior to NPWT.
NPWT pump (E2402) and supplies (A6550, A7000) are covered in the home setting for beneficiaries with a chronic (>=30 days) Stage 3 or 4 pressure ulcer, neuropathic (e.g., diabetic) ulcer, venous or arterial insufficiency ulcer, or a chronic ulcer of mixed etiology.
Coverage requires that a complete wound therapy program has been tried or considered and ruled out prior to application of NPWT.
General wound-therapy measures that must be addressed prior to NPWT include documentation of wound evaluation and measurements by a licensed medical professional.
General wound-therapy measures include application of dressings to maintain a moist wound environment prior to NPWT.
General wound-therapy measures include debridement of necrotic tissue when present prior to NPWT.

L33821 — Negative Pressure Wound Therapy Pumps

J19

HUMANA-NEGATIVE-PRESSURE-WOUND-THERAPY-MA — Negative Pressure Wound Therapy - Medicare Advantage

AETNA-CPB-0334 — Negative Pressure Wound Therapy

AETNA-CPB-0526 — Surgical Dressings (Wound Care Supplies)

ANTHEM-CG-DME-48 — CG-DME-48 Vacuum Assisted Wound Therapy in the Outpatient Setting

Ask Verity about documentation requirements, denial risks, or coverage in your state.