Aetna · Clinical coverage policy

Aetna Negative Pressure Wound Therapy coverage criteria

Aetna covers negative pressure wound therapy (NPWT) for Stage III-IV pressure ulcers, neuropathic/diabetic ulcers, venous insufficiency ulcers, and complications of surgical or traumatic wounds (including high-risk open fractures, post-sternotomy infection, dehiscence, and delayed flap/graft healing), but only after a complete wound care program has first been tried and the wound-type-specific criteria are met, and provided no absolute contraindication (e.g., untreated osteomyelitis, exposed bone/organs, infected wound, malignancy) is present. Approval runs in 30-day increments up to 12 weeks (recommended max 3 months) and continues only with documented, quantitatively measured progressive healing month to month; it is discontinued for no measurable healing, wound depth of 1 mm or less, or after 4 months. Single-use/mechanical NPWT devices, instillation systems (VeraFlo), AbThera, and numerous prophylactic/closed-incision surgical applications are experimental or not covered.

Policy CPB 0334 · Effective · Verify against the current Aetna policy before submitting — view source policy.

Payer

Aetna

Policy

CPB 0334

Prior auth

Confirm

Effective

January 1, 2026

This page reflects the coverage criteria captured from Aetna policy CPB 0334 and may not include every criterion, exception, or code — verify the complete bulletin before submitting.

What this means for the claim

The covered path, the next step to get it approved, and the specific way it denies — built only from this policy.

When does Aetna cover Negative Pressure Wound Therapy (CPT 97605), and what gets it denied?

Path
Aetna covers negative pressure wound therapy (NPWT) for Stage III-IV pressure ulcers, neuropathic/diabetic ulcers, venous insufficiency ulcers, and complications of surgical or traumatic wounds (including high-risk open fractures, post-sternotomy infection, dehiscence, and delayed flap/graft healing), but only after a complete wound care program has first been tried and the wound-type-specific criteria are met, and provided no absolute contraindication (e.g., untreated osteomyelitis, exposed bone/organs, infected wound, malignancy) is present. Approval runs in 30-day increments up to 12 weeks (recommended max 3 months) and continues only with documented, quantitatively measured progressive healing month to month; it is discontinued for no measurable healing, wound depth of 1 mm or less, or after 4 months. Single-use/mechanical NPWT devices, instillation systems (VeraFlo), AbThera, and numerous prophylactic/closed-incision surgical applications are experimental or not covered. Coverage criteria include: Complete wound care program must be tried first, meeting ALL of: (1) documentation of comprehensive evaluation including treatment plan and wound measurements by a licensed medical professional; (2) application of dressings that maintain a moist wound environment; (3) debridement of necrotic tissue if present; (4) evaluation and provision for adequate nutritional status; (5) underlying medical conditions appropriately managed; In addition to the wound care program, ONE OR MORE of the following eligible conditions must be documented (the four wound-type indications below, each with its own sub-criteria); Stage III or IV pressure ulcers — member must meet ALL of: (1) individual appropriately turned and positioned; (2) Group 2 or 3 support surface used for ulcers on posterior trunk/pelvis (or no special surface required for ulcers in other locations); (3) moisture and incontinence appropriately managed; Neuropathic ulcers (including diabetic) — member must meet BOTH of: (1) individual is on a comprehensive diabetic management program; (2) pressure reduction on the foot ulcer via appropriate modalities; Venous insufficiency ulcers — member must meet ALL of: (1) compression bandages/garments consistently applied; (2) pressure reduction via appropriate modalities; (3) for home initiation, ulcer present at least 30 days; (4) vascular evaluation with palpable arterial pulse and ankle-brachial index ≥ 0.8; Complications of surgical wounds or traumatic wounds — covered when accelerated granulation tissue formation is needed because comorbidities prevent wound healing with other topical treatments, for ONE OR MORE of: patient has autoimmune disease; OR patient using prescription transplant rejection drugs; OR patient with chronic prescription steroid use; OR post-operative dehiscence with a complete wound therapy program; OR open, non-healing amputation site in diabetics; OR post-sternotomy infection (mediastinitis); OR delayed healing/non-healing of a skin flap or graft due to irregular contour or inadequate blood flow; OR high-risk open fracture (Gustilo Grade III); Continuation of medical necessity: approval is for a total of 12 weeks in 30-day increments; Continuation beyond the first 30 days requires ALL of: (1) a licensed medical professional directly assesses the wound(s) regularly, supervises/performs dressing changes, and documents wound dimension and characteristic changes at least every 2 weeks; (2) wound shows progressive healing month to month; (3) adequate nutritional status provisions (normal albumin, prealbumin, and protein levels); (4) underlying medical conditions appropriately managed; Recommended maximum treatment duration is 3 months, unless otherwise medically indicated; Continuation beyond 4 months requires individual consideration based upon submission of clinical documentation; Supplies: maximum 15 dressing kits per wound per month, UNLESS documentation shows the wound size requires more per dressing change; Supplies: maximum 10 canister sets per month, UNLESS documentation shows drainage exceeding 90 ml exudate per day (high-volume wounds require a stationary pump with the largest-capacity canister). Applies to 8 codes: 97605, 97606, A6550, E2402, K0743, K0744, K0745, K0746.
Action
Confirm prior-authorization status with Aetna before scheduling — it is code- and plan-specific, and this policy is not an exact authorization source. Documentation: Comprehensive evaluation including treatment plan and wound measurements by a licensed medical professional; Documentation of wound care program components (moist dressing maintenance, debridement, nutritional management, underlying medical condition management); Specific wound information: measurements, location, and drainage; Progress notes and treatment plan at continuation reviews; Wound dimension and characteristic changes documented at least every 2 weeks (for continuation); Quantitative measurements of wound length, width, surface area, or depth serially documented; Evidence of progressive wound healing month to month; Nutritional status documentation (albumin, prealbumin, protein levels); For diabetic ulcers: HbA1c testing quarterly if therapy changed or glycemic goals not met; For venous insufficiency ulcers: vascular evaluation with palpable arterial pulse and ankle-brachial index ≥ 0.8; For high-volume exudate wounds: documentation of drainage exceeding 90 ml exudate per day.
Trap
Policy exclusions and limitations: Absolute contraindication (NPWT not medically necessary if present): exposed anastomotic site; Absolute contraindication (NPWT not medically necessary if present): exposed nerves; Absolute contraindication (NPWT not medically necessary if present): exposed organs; Absolute contraindication (NPWT not medically necessary if present): active bleeding or exposed vasculature in a member on anticoagulation therapy; Absolute contraindication (NPWT not medically necessary if present): malignancy in the wound; Absolute contraindication (NPWT not medically necessary if present): necrotic tissue with eschar present; Absolute contraindication (NPWT not medically necessary if present): non-enteric and unexplored fistulas; Absolute contraindication (NPWT not medically necessary if present): untreated osteomyelitis; Absolute contraindication (NPWT not medically necessary if present): contaminated wound; Absolute contraindication (NPWT not medically necessary if present): exposed bone; Absolute contraindication (NPWT not medically necessary if present): infected wounds; Discontinuation — NPWT not medically necessary if: no measurable wound healing over the prior month (requires documented quantitative measurements); Discontinuation — NPWT not medically necessary if: wound depth is 1 mm or less (cannot accommodate the sponge); Discontinuation — NPWT not medically necessary if: four months have elapsed using the NPWT pump (including inpatient time); Discontinuation — NPWT not medically necessary if: individual cannot tolerate NPWT; Discontinuation — NPWT not medically necessary if: equipment/supplies are no longer being used; Discontinuation — NPWT not medically necessary if: continuation criteria are not met; Excess canister use related to equipment failure is not medically necessary; Experimental/investigational: chemotherapeutic agents (e.g., doxycycline, insulin) used in continuous/intermittent-instillation NPWT; Experimental/investigational: non-powered (mechanical) NPWT devices (e.g., Smart Negative Pressure [SNaP]); Experimental/investigational: single-use NPWT devices for ALL indications (e.g., PICO Single Use System; Prevena Incision Management System), including keloid scarring, closed sternal incision after thoracic grafting, post-mammoplasty, and prophylaxis after lower extremity fracture surgery; Experimental/investigational: VeraFlo (intermittent instillation wound vacuum) for wound healing, including diabetic foot ulcer; Experimental/investigational: AbThera Open Abdomen Negative Pressure Therapy System; NPWT not covered for: surgical excision of pilonidal sinus disease and recurrent pilonidal disease; NPWT not covered for: donor-site closure in radial forearm free flap; NPWT not covered for vascular surgery: closed groin incisions in arterial surgery; infra-inguinal re-vascularization with groin incision; NPWT not covered for: prevention of complications from prosthetic breast reconstruction; NPWT not covered for: prevention of complications in surgical abdominal wounds based on diabetes/obesity as risk factors; NPWT not covered for: prophylactic sternal wound infection prevention; NPWT not covered for: prophylactic prevention of surgical site infection in uncomplicated abdominal surgical wounds; NPWT not covered for: prophylactic use after cesarean delivery; NPWT not covered for: prophylactic use after ventral hernia repairs; NPWT not covered for: prophylactic use on surgical site infections in pancreatic resection; NPWT not covered for: prophylactic use for partial-, full-, and deep-thickness burns; Closed incision NPWT (ciNPWT) not covered for: prevention of SSI or dehiscence after spinal fusion; Closed incision NPWT (ciNPWT) not covered for: prevention of SSI or dehiscence after primary total joint arthroplasty; Closed incision NPWT (ciNPWT) not covered for: prevention of SSI or dehiscence after cardiac surgery; Closed incision NPWT (ciNPWT) not covered for: prevention of SSI or dehiscence after lower extremity bypass. Claims may be denied when the requested service falls under these.

Source: Aetna CPB 0334 — Negative Pressure Wound Therapy

Coverage criteria

  • Complete wound care program must be tried first, meeting ALL of: (1) documentation of comprehensive evaluation including treatment plan and wound measurements by a licensed medical professional; (2) application of dressings that maintain a moist wound environment; (3) debridement of necrotic tissue if present; (4) evaluation and provision for adequate nutritional status; (5) underlying medical conditions appropriately managed
  • In addition to the wound care program, ONE OR MORE of the following eligible conditions must be documented (the four wound-type indications below, each with its own sub-criteria)
  • Stage III or IV pressure ulcers — member must meet ALL of: (1) individual appropriately turned and positioned; (2) Group 2 or 3 support surface used for ulcers on posterior trunk/pelvis (or no special surface required for ulcers in other locations); (3) moisture and incontinence appropriately managed
  • Neuropathic ulcers (including diabetic) — member must meet BOTH of: (1) individual is on a comprehensive diabetic management program; (2) pressure reduction on the foot ulcer via appropriate modalities
  • Venous insufficiency ulcers — member must meet ALL of: (1) compression bandages/garments consistently applied; (2) pressure reduction via appropriate modalities; (3) for home initiation, ulcer present at least 30 days; (4) vascular evaluation with palpable arterial pulse and ankle-brachial index ≥ 0.8
  • Complications of surgical wounds or traumatic wounds — covered when accelerated granulation tissue formation is needed because comorbidities prevent wound healing with other topical treatments, for ONE OR MORE of: patient has autoimmune disease; OR patient using prescription transplant rejection drugs; OR patient with chronic prescription steroid use; OR post-operative dehiscence with a complete wound therapy program; OR open, non-healing amputation site in diabetics; OR post-sternotomy infection (mediastinitis); OR delayed healing/non-healing of a skin flap or graft due to irregular contour or inadequate blood flow; OR high-risk open fracture (Gustilo Grade III)
  • Continuation of medical necessity: approval is for a total of 12 weeks in 30-day increments
  • Continuation beyond the first 30 days requires ALL of: (1) a licensed medical professional directly assesses the wound(s) regularly, supervises/performs dressing changes, and documents wound dimension and characteristic changes at least every 2 weeks; (2) wound shows progressive healing month to month; (3) adequate nutritional status provisions (normal albumin, prealbumin, and protein levels); (4) underlying medical conditions appropriately managed
  • Recommended maximum treatment duration is 3 months, unless otherwise medically indicated
  • Continuation beyond 4 months requires individual consideration based upon submission of clinical documentation
  • Supplies: maximum 15 dressing kits per wound per month, UNLESS documentation shows the wound size requires more per dressing change
  • Supplies: maximum 10 canister sets per month, UNLESS documentation shows drainage exceeding 90 ml exudate per day (high-volume wounds require a stationary pump with the largest-capacity canister)

Covered codes

Codes listed in this Aetna policy. Check each one's prior-authorization verdict and Medicare rate:

Documentation required

  • Comprehensive evaluation including treatment plan and wound measurements by a licensed medical professional
  • Documentation of wound care program components (moist dressing maintenance, debridement, nutritional management, underlying medical condition management)
  • Specific wound information: measurements, location, and drainage
  • Progress notes and treatment plan at continuation reviews
  • Wound dimension and characteristic changes documented at least every 2 weeks (for continuation)
  • Quantitative measurements of wound length, width, surface area, or depth serially documented
  • Evidence of progressive wound healing month to month
  • Nutritional status documentation (albumin, prealbumin, protein levels)
  • For diabetic ulcers: HbA1c testing quarterly if therapy changed or glycemic goals not met
  • For venous insufficiency ulcers: vascular evaluation with palpable arterial pulse and ankle-brachial index ≥ 0.8
  • For high-volume exudate wounds: documentation of drainage exceeding 90 ml exudate per day

Frequently asked questions

When does Aetna cover Negative Pressure Wound Therapy (CPT 97605), and what gets it denied?
Aetna covers negative pressure wound therapy (NPWT) for Stage III-IV pressure ulcers, neuropathic/diabetic ulcers, venous insufficiency ulcers, and complications of surgical or traumatic wounds (including high-risk open fractures, post-sternotomy infection, dehiscence, and delayed flap/graft healing), but only after a complete wound care program has first been tried and the wound-type-specific criteria are met, and provided no absolute contraindication (e.g., untreated osteomyelitis, exposed bone/organs, infected wound, malignancy) is present. Approval runs in 30-day increments up to 12 weeks (recommended max 3 months) and continues only with documented, quantitatively measured progressive healing month to month; it is discontinued for no measurable healing, wound depth of 1 mm or less, or after 4 months. Single-use/mechanical NPWT devices, instillation systems (VeraFlo), AbThera, and numerous prophylactic/closed-incision surgical applications are experimental or not covered. Coverage criteria include: Complete wound care program must be tried first, meeting ALL of: (1) documentation of comprehensive evaluation including treatment plan and wound measurements by a licensed medical professional; (2) application of dressings that maintain a moist wound environment; (3) debridement of necrotic tissue if present; (4) evaluation and provision for adequate nutritional status; (5) underlying medical conditions appropriately managed; In addition to the wound care program, ONE OR MORE of the following eligible conditions must be documented (the four wound-type indications below, each with its own sub-criteria); Stage III or IV pressure ulcers — member must meet ALL of: (1) individual appropriately turned and positioned; (2) Group 2 or 3 support surface used for ulcers on posterior trunk/pelvis (or no special surface required for ulcers in other locations); (3) moisture and incontinence appropriately managed; Neuropathic ulcers (including diabetic) — member must meet BOTH of: (1) individual is on a comprehensive diabetic management program; (2) pressure reduction on the foot ulcer via appropriate modalities; Venous insufficiency ulcers — member must meet ALL of: (1) compression bandages/garments consistently applied; (2) pressure reduction via appropriate modalities; (3) for home initiation, ulcer present at least 30 days; (4) vascular evaluation with palpable arterial pulse and ankle-brachial index ≥ 0.8; Complications of surgical wounds or traumatic wounds — covered when accelerated granulation tissue formation is needed because comorbidities prevent wound healing with other topical treatments, for ONE OR MORE of: patient has autoimmune disease; OR patient using prescription transplant rejection drugs; OR patient with chronic prescription steroid use; OR post-operative dehiscence with a complete wound therapy program; OR open, non-healing amputation site in diabetics; OR post-sternotomy infection (mediastinitis); OR delayed healing/non-healing of a skin flap or graft due to irregular contour or inadequate blood flow; OR high-risk open fracture (Gustilo Grade III); Continuation of medical necessity: approval is for a total of 12 weeks in 30-day increments; Continuation beyond the first 30 days requires ALL of: (1) a licensed medical professional directly assesses the wound(s) regularly, supervises/performs dressing changes, and documents wound dimension and characteristic changes at least every 2 weeks; (2) wound shows progressive healing month to month; (3) adequate nutritional status provisions (normal albumin, prealbumin, and protein levels); (4) underlying medical conditions appropriately managed; Recommended maximum treatment duration is 3 months, unless otherwise medically indicated; Continuation beyond 4 months requires individual consideration based upon submission of clinical documentation; Supplies: maximum 15 dressing kits per wound per month, UNLESS documentation shows the wound size requires more per dressing change; Supplies: maximum 10 canister sets per month, UNLESS documentation shows drainage exceeding 90 ml exudate per day (high-volume wounds require a stationary pump with the largest-capacity canister). Applies to 8 codes: 97605, 97606, A6550, E2402, K0743, K0744, K0745, K0746. Confirm prior-authorization status with Aetna before scheduling — it is code- and plan-specific, and this policy is not an exact authorization source. Documentation: Comprehensive evaluation including treatment plan and wound measurements by a licensed medical professional; Documentation of wound care program components (moist dressing maintenance, debridement, nutritional management, underlying medical condition management); Specific wound information: measurements, location, and drainage; Progress notes and treatment plan at continuation reviews; Wound dimension and characteristic changes documented at least every 2 weeks (for continuation); Quantitative measurements of wound length, width, surface area, or depth serially documented; Evidence of progressive wound healing month to month; Nutritional status documentation (albumin, prealbumin, protein levels); For diabetic ulcers: HbA1c testing quarterly if therapy changed or glycemic goals not met; For venous insufficiency ulcers: vascular evaluation with palpable arterial pulse and ankle-brachial index ≥ 0.8; For high-volume exudate wounds: documentation of drainage exceeding 90 ml exudate per day. Policy exclusions and limitations: Absolute contraindication (NPWT not medically necessary if present): exposed anastomotic site; Absolute contraindication (NPWT not medically necessary if present): exposed nerves; Absolute contraindication (NPWT not medically necessary if present): exposed organs; Absolute contraindication (NPWT not medically necessary if present): active bleeding or exposed vasculature in a member on anticoagulation therapy; Absolute contraindication (NPWT not medically necessary if present): malignancy in the wound; Absolute contraindication (NPWT not medically necessary if present): necrotic tissue with eschar present; Absolute contraindication (NPWT not medically necessary if present): non-enteric and unexplored fistulas; Absolute contraindication (NPWT not medically necessary if present): untreated osteomyelitis; Absolute contraindication (NPWT not medically necessary if present): contaminated wound; Absolute contraindication (NPWT not medically necessary if present): exposed bone; Absolute contraindication (NPWT not medically necessary if present): infected wounds; Discontinuation — NPWT not medically necessary if: no measurable wound healing over the prior month (requires documented quantitative measurements); Discontinuation — NPWT not medically necessary if: wound depth is 1 mm or less (cannot accommodate the sponge); Discontinuation — NPWT not medically necessary if: four months have elapsed using the NPWT pump (including inpatient time); Discontinuation — NPWT not medically necessary if: individual cannot tolerate NPWT; Discontinuation — NPWT not medically necessary if: equipment/supplies are no longer being used; Discontinuation — NPWT not medically necessary if: continuation criteria are not met; Excess canister use related to equipment failure is not medically necessary; Experimental/investigational: chemotherapeutic agents (e.g., doxycycline, insulin) used in continuous/intermittent-instillation NPWT; Experimental/investigational: non-powered (mechanical) NPWT devices (e.g., Smart Negative Pressure [SNaP]); Experimental/investigational: single-use NPWT devices for ALL indications (e.g., PICO Single Use System; Prevena Incision Management System), including keloid scarring, closed sternal incision after thoracic grafting, post-mammoplasty, and prophylaxis after lower extremity fracture surgery; Experimental/investigational: VeraFlo (intermittent instillation wound vacuum) for wound healing, including diabetic foot ulcer; Experimental/investigational: AbThera Open Abdomen Negative Pressure Therapy System; NPWT not covered for: surgical excision of pilonidal sinus disease and recurrent pilonidal disease; NPWT not covered for: donor-site closure in radial forearm free flap; NPWT not covered for vascular surgery: closed groin incisions in arterial surgery; infra-inguinal re-vascularization with groin incision; NPWT not covered for: prevention of complications from prosthetic breast reconstruction; NPWT not covered for: prevention of complications in surgical abdominal wounds based on diabetes/obesity as risk factors; NPWT not covered for: prophylactic sternal wound infection prevention; NPWT not covered for: prophylactic prevention of surgical site infection in uncomplicated abdominal surgical wounds; NPWT not covered for: prophylactic use after cesarean delivery; NPWT not covered for: prophylactic use after ventral hernia repairs; NPWT not covered for: prophylactic use on surgical site infections in pancreatic resection; NPWT not covered for: prophylactic use for partial-, full-, and deep-thickness burns; Closed incision NPWT (ciNPWT) not covered for: prevention of SSI or dehiscence after spinal fusion; Closed incision NPWT (ciNPWT) not covered for: prevention of SSI or dehiscence after primary total joint arthroplasty; Closed incision NPWT (ciNPWT) not covered for: prevention of SSI or dehiscence after cardiac surgery; Closed incision NPWT (ciNPWT) not covered for: prevention of SSI or dehiscence after lower extremity bypass. Claims may be denied when the requested service falls under these.
Does Aetna require prior authorization for Negative Pressure Wound Therapy?
Confirm prior-authorization status with Aetna before scheduling — it is code- and plan-specific, and this policy is not an exact authorization source. Documentation: Comprehensive evaluation including treatment plan and wound measurements by a licensed medical professional; Documentation of wound care program components (moist dressing maintenance, debridement, nutritional management, underlying medical condition management); Specific wound information: measurements, location, and drainage; Progress notes and treatment plan at continuation reviews; Wound dimension and characteristic changes documented at least every 2 weeks (for continuation); Quantitative measurements of wound length, width, surface area, or depth serially documented; Evidence of progressive wound healing month to month; Nutritional status documentation (albumin, prealbumin, protein levels); For diabetic ulcers: HbA1c testing quarterly if therapy changed or glycemic goals not met; For venous insufficiency ulcers: vascular evaluation with palpable arterial pulse and ankle-brachial index ≥ 0.8; For high-volume exudate wounds: documentation of drainage exceeding 90 ml exudate per day.
What does Aetna exclude for Negative Pressure Wound Therapy?
Policy exclusions and limitations: Absolute contraindication (NPWT not medically necessary if present): exposed anastomotic site; Absolute contraindication (NPWT not medically necessary if present): exposed nerves; Absolute contraindication (NPWT not medically necessary if present): exposed organs; Absolute contraindication (NPWT not medically necessary if present): active bleeding or exposed vasculature in a member on anticoagulation therapy; Absolute contraindication (NPWT not medically necessary if present): malignancy in the wound; Absolute contraindication (NPWT not medically necessary if present): necrotic tissue with eschar present; Absolute contraindication (NPWT not medically necessary if present): non-enteric and unexplored fistulas; Absolute contraindication (NPWT not medically necessary if present): untreated osteomyelitis; Absolute contraindication (NPWT not medically necessary if present): contaminated wound; Absolute contraindication (NPWT not medically necessary if present): exposed bone; Absolute contraindication (NPWT not medically necessary if present): infected wounds; Discontinuation — NPWT not medically necessary if: no measurable wound healing over the prior month (requires documented quantitative measurements); Discontinuation — NPWT not medically necessary if: wound depth is 1 mm or less (cannot accommodate the sponge); Discontinuation — NPWT not medically necessary if: four months have elapsed using the NPWT pump (including inpatient time); Discontinuation — NPWT not medically necessary if: individual cannot tolerate NPWT; Discontinuation — NPWT not medically necessary if: equipment/supplies are no longer being used; Discontinuation — NPWT not medically necessary if: continuation criteria are not met; Excess canister use related to equipment failure is not medically necessary; Experimental/investigational: chemotherapeutic agents (e.g., doxycycline, insulin) used in continuous/intermittent-instillation NPWT; Experimental/investigational: non-powered (mechanical) NPWT devices (e.g., Smart Negative Pressure [SNaP]); Experimental/investigational: single-use NPWT devices for ALL indications (e.g., PICO Single Use System; Prevena Incision Management System), including keloid scarring, closed sternal incision after thoracic grafting, post-mammoplasty, and prophylaxis after lower extremity fracture surgery; Experimental/investigational: VeraFlo (intermittent instillation wound vacuum) for wound healing, including diabetic foot ulcer; Experimental/investigational: AbThera Open Abdomen Negative Pressure Therapy System; NPWT not covered for: surgical excision of pilonidal sinus disease and recurrent pilonidal disease; NPWT not covered for: donor-site closure in radial forearm free flap; NPWT not covered for vascular surgery: closed groin incisions in arterial surgery; infra-inguinal re-vascularization with groin incision; NPWT not covered for: prevention of complications from prosthetic breast reconstruction; NPWT not covered for: prevention of complications in surgical abdominal wounds based on diabetes/obesity as risk factors; NPWT not covered for: prophylactic sternal wound infection prevention; NPWT not covered for: prophylactic prevention of surgical site infection in uncomplicated abdominal surgical wounds; NPWT not covered for: prophylactic use after cesarean delivery; NPWT not covered for: prophylactic use after ventral hernia repairs; NPWT not covered for: prophylactic use on surgical site infections in pancreatic resection; NPWT not covered for: prophylactic use for partial-, full-, and deep-thickness burns; Closed incision NPWT (ciNPWT) not covered for: prevention of SSI or dehiscence after spinal fusion; Closed incision NPWT (ciNPWT) not covered for: prevention of SSI or dehiscence after primary total joint arthroplasty; Closed incision NPWT (ciNPWT) not covered for: prevention of SSI or dehiscence after cardiac surgery; Closed incision NPWT (ciNPWT) not covered for: prevention of SSI or dehiscence after lower extremity bypass. Claims may be denied when the requested service falls under these.

Source

Aetna CPB 0334 — Negative Pressure Wound Therapy

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Coverage disclaimer

This page summarizes Aetna clinical-coverage criteria extracted from policy CPB 0334 for educational purposes. Coverage policies change and vary by individual plan. Always verify against Aetna's current policy before performing a procedure or submitting a claim. d3rx is not responsible for claim denials or reimbursement issues.