Negative Pressure Wound Therapy – Commercial and Individual Exchange Medical Policyopen_in_new

UnitedHealthcare covers outpatient (or at‑discharge) NPWT only for specified open wounds — Stage III/IV pressure ulcers, neuropathic/diabetic ulcers, venous insufficiency ulcers, certain open surgical wounds (e.g., post‑op dehiscence, non‑healing diabetic amputation sites, post‑sternotomy infection, problematic grafts) and Gustilo Grade III open fractures — and lists NPWT for closed incisions, pilonidal disease, disposable single‑use systems, and instillation systems as unproven/not medically necessary; NPWT is contraindicated with active bleeding/exposed vasculature, anticoagulation, untreated osteomyelitis/uncontrolled infection, malignancy in the wound, eschar, exposed bone/nerves/organs, or open fistulae. Coverage requires documented trial (or considered and ruled out) of a complete wound therapy program with evaluation/wound measurements, moist dressings, debridement if present, nutrition assessment, provider rationale and failure of conventional treatment after 30 days, plus condition‑specific prerequisites (e.g., ≥30 days compression for venous ulcers, comprehensive diabetic management and offloading for neuropathic ulcers) and weekly provider assessments with defined discontinuation criteria.