CurrentAmbetter NevadaPolicy CP.MP.139

Low-Frequency Ultrasound and Noncontact Normothermic Wound Therapy

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This policy governs coverage of low-frequency, noncontact ultrasound wound therapy and noncontact normothermic wound therapy for wound management. Current evidence does not support either therapy.

Policy Summary

PayerAmbetter Nevada

PolicyLow-Frequency Ultrasound and Noncontact Normothermic Wound Therapy

Policy CodePolicy CP.MP.139

Change TypeNo material change

Effective DateOct 1, 2026

Last ReviewMar 1, 2026

Next Review DateN/A

Key ActionFor Medicare members and enrollees, review all applicable Medicare National Coverage Determinations, Local Coverage Determinations, and Medicare Coverage Articles before applying this policy.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

2Therapies unsupported by current evidence

2Low-frequency ultrasound trials identified

63% vs 29%Greater than 50% wound healing at 12 weeks

85%Wound-area reduction with NNWT

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CurrentAmbetter NevadaPolicy CP.MP.139

Low-Frequency Ultrasound and Noncontact Normothermic Wound Therapy

Customize your policy alerts

Sign up for Ambetter Nevada Policy CP.MP.139 alerts

Get alerted when Policy CP.MP.139 changes without checking for updates manually.

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This policy governs coverage of low-frequency, noncontact ultrasound wound therapy and noncontact normothermic wound therapy for wound management. Current evidence does not support either therapy.

Policy Summary

PayerAmbetter Nevada

PolicyLow-Frequency Ultrasound and Noncontact Normothermic Wound Therapy

Policy CodePolicy CP.MP.139

Change TypeNo material change

Effective DateOct 1, 2026

Last ReviewMar 1, 2026

Next Review DateN/A

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

2Therapies unsupported by current evidence

2Low-frequency ultrasound trials identified

63% vs 29%Greater than 50% wound healing at 12 weeks

85%Wound-area reduction with NNWT

Coverage Criteria

Low-frequency ultrasound

Not supported by current evidence.

Low-frequency ultrasound wound therapy: Current evidence does not support the use of low-frequency ultrasound wound therapy.

Noncontact normothermic wound therapy

Not supported by current evidence.

Noncontact normothermic wound therapy: Current evidence does not support the use of noncontact normothermic wound therapy (NNWT).

Coding

CPT CodeCPT

97610

Low frequency, non-contact, non-thermal ultrasound, including topical application(s) when performed, wound assessment, and instruction(s) for ongoing care; per day

HCPCS CodesHCPCS

E0231	Noncontact wound-warming device (temperature control unit, AC adapter and power cord) for use with warming card and wound cover.
E0232	Warming card for use with the noncontact wound-warming device and noncontact wound-warming wound cover

Provider Actions

Prior Authorization

Review Medicare coverage guidance

For Medicare members/enrollees, review all applicable Medicare National Coverage Determinations (NCDs), Local Coverage Determinations (LCDs), and Medicare Coverage Articles before applying this policy’s criteria.

Denial Risk

Unsupported wound therapies

Coverage may be denied because current evidence does not support the use of low-frequency ultrasound wound therapy or noncontact normothermic wound therapy (NNWT).

Background

The policy addresses low-frequency ultrasound debridement and noncontact normothermic wound therapy as treatments for chronic and difficult-to-heal wounds. Low-frequency ultrasound is a noncontact method that atomizes saline into a continuous mist to cleanse the wound and remove necrotic tissue, fibrosis, exudate, and bacteria. Noncontact normothermic wound therapy uses radiant heat to maintain 100% relative humidity and warm the wound bed to normothermia. Chronic wound healing also depends on adequate vascularization, removal of devitalized tissue, infection control, and a moist wound environment; surgical debridement is identified as the preferred approach for large areas of necrosis or when infection is present.

Definitions

Low-Frequency Ultrasound Debridement

MethodA noncontact debridement method that provides simultaneous cleansing and debridement of wounds.

Operating distanceGenerally performed 5 mm to 15 mm from the wound surface.

OperationUltrasound atomizes saline into a continuous mist delivered to the treatment site; the treatment head makes multiple passes over the wound during a predetermined treatment session.

Noncontact Normothermic Wound Therapy (NNWT)

MechanismUses radiant heat to warm the wound bed to normothermia.

Wound environmentMaintains 100% relative humidity to provide an environment intended to promote wound healing.