Payer PolicyActive
Negative Pressure Wound Therapy - DME.SW.105.A
EVICORE-DME-C8D2DBB0
EviCore by Evernorth
Effective: November 15, 2024
Updated: January 13, 2026
created · Dec 4, 2025
Policy Summary
Continued rental of negative pressure wound therapy (HCPCS A6550, A7000, E2402) is covered only for ongoing use when wound healing is documented to be progressing. Key requirements are monthly wound length/width/depth measurements and physician documentation of proper use and continued benefit; absence of any of these criteria contraindicates continued rental.
Coverage Criteria Preview
Key requirements from the full policy
"Documentation that wound healing is progressing"
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Covered Medical Codes