Medicare (CMS LCD/NCD) Negative Pressure Wound Therapy (NPWT) prior authorization requirements (2026)
What Medicare (CMS LCD/NCD) generally requires to approve Negative Pressure Wound Therapy (NPWT) (CPT 97605, 97606, E2402, A6550, A7000), for Medicare plans. Based on the cited policy, Medicare (CMS LCD/NCD) does not generally require prior authorization for Negative Pressure Wound Therapy (NPWT) (CPT 97605, 97606, E2402, A6550, A7000). Confirm with Medicare (CMS LCD/NCD), as this can vary by plan.
Medical-necessity criteria Medicare (CMS LCD/NCD) generally applies
No general prior authorization for the office application codes (97605/97606). The pump (E2402) is DME per LCD L33821 (Negative Pressure Wound Therapy Pumps): coverage requires a qualifying ulcer/wound category per the LCD with a documented trial and failure of the prior wound-treatment regimen, and CONTINUED coverage requires ongoing documentation of wound dimensions showing the wound is responding - lapsed measurement documentation is the classic NPWT claim failure. Verify E2402 against the current CMS DMEPOS Required Prior Authorization List before dispensing. Read the current LCD for the qualifying ulcer categories and continued-use limits rather than relying on this summary. [NEEDS CLINICAL SPOT-CHECK]
Commonly required documentation
- Wound history with the failed prior treatment regimen, baseline and serial wound measurements, the qualifying wound category per the LCD, and the ordering documentation for the pump and supplies.
How to submit
- Method: No PA for office application - bill Part B. Pump/supplies: bill the DME MAC (NJ = Jurisdiction A, Noridian) with LCD L33821 documentation on file.
Sources & verification
Source: DME MAC LCD L33821, Negative Pressure Wound Therapy Pumps, eff. 01/01/2024 (cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=33821, verified 2026-07-10). Last verified 2026-07-10.
Frequently asked questions
Does Medicare (CMS LCD/NCD) require prior authorization for Negative Pressure Wound Therapy (NPWT)?
Based on the cited policy, Medicare (CMS LCD/NCD) does not generally require prior authorization for Negative Pressure Wound Therapy (NPWT) (CPT 97605, 97606, E2402, A6550, A7000). Confirm with Medicare (CMS LCD/NCD), as this can vary by plan.
What does Medicare (CMS LCD/NCD) require to approve Negative Pressure Wound Therapy (NPWT)?
No general prior authorization for the office application codes (97605/97606). The pump (E2402) is DME per LCD L33821 (Negative Pressure Wound Therapy Pumps): coverage requires a qualifying ulcer/wound category per the LCD with a documented trial and failure of the prior wound-treatment regimen, and CONTINUED coverage requires ongoing documentation of wound dimensions showing the wound is respondi… Always confirm against the current Medicare (CMS LCD/NCD) policy.
How long does a Medicare (CMS LCD/NCD) prior authorization take?
Turnaround varies by plan and submission method. Check the Medicare (CMS LCD/NCD) portal for current timeframes.
Submitting Negative Pressure Wound Therapy (NPWT) to Medicare (CMS LCD/NCD)?
Praxigen checks your clinical note against these criteria before you submit and drafts a policy-cited appeal if it is denied. You review and submit; nothing is sent automatically.