ModifiedCignaPolicy 0064

Negative Pressure Wound Therapy/Vacuum Assisted Closure (VAC) for Nonhealing Wounds

This Cigna coverage policy governs coverage and reimbursement for disposable non-powered mechanical and single-use battery-powered NPWT/VAC devices for nonhealing wounds across applicable care settings and applies to services billed to Cigna-administered health benefit plans.

Policy Summary

PayerCigna

PolicyNegative Pressure Wound Therapy/Vacuum Assisted Closure (VAC) for Nonhealing Wounds

Policy CodePolicy 0064

Change TypeRemoval and revision of powered NPWT languageupdates to disposable device coverage

Effective DateMay 15, 2026

Next Review DateMay 15, 2027

Key ActionDo not bill or request coverage for disposable non-powered or single-use battery-powered NPWT devices (CPT 97607, 97608; HCPCS A9272) as they are not covered.

SourceLink

POLICY UPDATE CHANGES

Removed policy statement for powered negative pressure wound therapy.

Revised policy statement for non-powered mechanical wound care devices and single use battery-powered devices.

Revised policy statements for powered negative pressure wound therapy (NPWT)/vacuum-assisted closure (VAC) for nonhealing wounds.

97607, 97608, A9272CPT/HCPCS codes explicitly listed as not covered

7-14 daysTypical fixed duration of single-use devices

3recent annual review entries listed

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Multiplesupporting references cited

Coverage Criteria

inv-01: Not Covered - Disposable NPWT

Covered when statement: None — the following disposable NPWT devices are excluded from coverage.

Not covered devices: Disposable non-powered mechanical NPWT and single-use battery-powered NPWT devices (examples listed) are not covered or reimbursable for ANY indication.

Claims for these devices and CPT codes 97607, 97608 and HCPCS code A9272 will be denied.

inv-02: Powered NPWT - Clinical context

Clinical intent (informational):

Powered NPWT intended use: Powered NPWT/VAC systems are typically used to treat large, deep, complex, or heavily exudating wounds and may be used for weeks to months in hospital, long-term care, skilled nursing, or home health settings. These systems are electrically powered (AC and/or rechargeable battery), have adjustable continuous or intermittent pressure settings, and use an external canister for moderate to heavy exudate.pressure range variable; duration: weeks to months

Descriptive only — powered systems differ from disposable single-use or mechanical devices.

inv-03: Trial-based eligibility constructs

Evidence from randomized trials and systematic reviews supports use in selected settings when ALL of the following are met (examples derived from trial eligibility and endpoints):

Incisional (iNPWT) trial-like criteria: Patient has a clean, primarily closed surgical incision appropriate for incisional NPWT (examples: vascular groin incision after revascularization, high-risk reoperative colorectal incision); patient is adult and not pregnant; no active incision/site infection; incision amenable to device application and seal; trial outcomes assessed within 7–30 days (e.g., surgical site occurrence or infection).adult; no active infection; incision closed; follow-up 7–30 days

Based on PICO-Vasc and other iNPWT randomized trials.

Chronic ulcer s-NPWT trial-like criteria: Chronic lower-extremity ulcer present for >4 weeks despite appropriate standard care; wound size within trial-specified ranges (examples: VLU 2–36 cm2; DFU 0.5–10 cm2 or other trial-defined limits); documented adequate arterial perfusion (eg, TcPO2 >30 mmHg or skin perfusion pressure >30 mmHg or ABI 0.7–1.2); wound location amenable to an airtight seal; absence of active infection or untreated osteomyelitis; no recent treatment with NPWT, growth factors, hyperbaric oxygen, or bioengineered tissue product within trial-specified washout (eg, 30 days).>4 weeks duration; perfusion thresholds as stated; wound size per trial

The U.S. Food and Drug Administration (FDA) identifies specific wound types and conditions for which negative pressure wound therapy (NPWT) is contraindicated. NPWT should not be used for wounds with necrotic tissue with eschar present, untreated osteomyelitis, or non-enteric and unexplored fistulas. The FDA also lists wounds with malignancy in the wound, or with exposed vasculature, exposed nerves, exposed anastomotic sites, or exposed organs as contraindications. Providers should review device labeling and monitor patients frequently when considering NPWT and avoid use when any of these contraindications are present.

Clinical and trial exclusion criteria commonly preclude NPWT when there is evidence of active infection (for example, redness, swelling, pain, or purulent exudate) or when untreated osteomyelitis is present. Trials and the policy also exclude wounds with malignancy in the target ulcer and wounds located where an airtight seal cannot be created (i.e., wounds not amenable to therapy). Other frequent exclusions noted in studies include pregnancy, known allergies to device components, recent use of NPWT or other advanced therapies, uncontrolled hyperglycemia (HbA1c > 12%), and patients receiving active chemotherapy or with end-stage renal disease on dialysis.

Operationally, the policy's prior wording about coverage for powered negative pressure wound therapy (NPWT) was deleted during the annual review on 5/15/2026. The revision notes that policy statements for powered NPWT were removed, and providers should not rely on earlier powered-NPWT coverage language when making billing or coverage requests.

The available peer-reviewed literature does not demonstrate that disposable non-powered mechanical NPWT or single-use battery-powered NPWT is superior to standard wound dressings. Studies are generally limited by small sample sizes, lack of appropriate comparators, and loss to follow-up; therefore, the evidence is insufficient to draw firm conclusions about the safety, efficacy, or improved clinical outcomes of these disposable systems compared with standard treatment.

Evidence for prophylactic or incisional NPWT (iNPWT) is mixed and currently insufficient to recommend routine, widespread use across surgical specialties. Systematic reviews and randomized trials (including PICO-Vasc and other iNPWT studies) report heterogeneity in outcomes and limitations in study designs. Some analyses show reductions in certain complications (for example, decreases in seroma or early surgical-site occurrences), but larger, higher-quality trials have not consistently demonstrated reductions in 30‑day surgical site infection rates; therefore, broad prophylactic application of iNPWT is not supported by the existing evidence base.

Coding

Not Covered CodesmixedNot Covered

97607	Negative pressure wound therapy, (eg, vacuum assisted drainage collection), utilizing disposable, non-durable medical equipment including provision of exudate management collection system, topical application(s), wound assessment, and instructions for ongoing care, per session; total wound(s) surface area less than or equal to 50 square centimeters
97608	Negative pressure wound therapy, (eg, vacuum assisted drainage collection), utilizing disposable, non-durable medical equipment including provision of exudate management collection system, topical application(s), wound assessment, and instructions for ongoing care, per session; total wound(s) surface area greater than 50 square centimeters
A9272	Wound suction, disposable, includes dressing, all accessories and components, any type, each

Wound surface area (coding thresholds)

Wound surface area — CPT 97607Total wound surface area less than or equal to 50 square centimeters

Wound surface area — CPT 97608Total wound surface area greater than 50 square centimeters

HCPCS A9272Wound suction, disposable, includes dressing and accessories (code listed with disposables)

Adequate blood perfusion criteria

Transcutaneous oxygen (TcPO2)TcPO2 > 30 mmHg indicates adequate perfusion

Skin perfusion pressureSkin perfusion pressure > 30 mmHg indicates adequate perfusion

Provider Actions and Billing Guidance

Prior Authorization

Prior Authorization Likely Required

Prior authorization is likely required for NPWT when used for chronic wounds. Documentation should demonstrate the wound is chronic (present >4 weeks despite appropriate care), wound size and location, and adequate arterial perfusion (for example, TcPO2 > 30 mmHg, skin perfusion pressure >30 mmHg, or ankle–brachial index 0.7–1.2). Requests that do not include required clinical information may be delayed or denied.

Prior authorization expected for chronic wound NPWT (>4 weeks)
Document wound duration, size, and perfusion (TcPO2, SPP, or ABI)

Denial Risk

Devices and Codes Not Covered

Claims for disposable non-powered mechanical and single-use battery-powered NPWT/VAC devices are not covered for any indication. Examples include non-powered mechanical systems (e.g., SNaP) and single-use battery-powered systems (e.g., PICO, Prevena, V.A.C. Via, MyNeWT, Uno). Deny or do not reimburse services billed with CPT codes 97607, 97608 or HCPCS code A9272 when they represent these disposable devices.

Background

Chronic wounds (also referred to as ulcers) are wounds that fail to progress through the normal healing process within the expected timeframe (typically around 30 days). Common chronic wound types include diabetic foot ulcers, venous leg ulcers, pressure ulcers, and arterial ulcers. Negative pressure wound therapy (NPWT) is a modality that applies localized vacuum to remove exudate and promote granulation tissue formation; NPWT may be used in hospitals, outpatient clinics, long-term care, and home health settings depending on device type and patient needs.

Definitions

Disposable non-powered mechanical NPWT — key features

DefinitionDisposable non-powered mechanical NPWT uses mechanical energy (spring/coil or elastomeric mechanism) to generate negative pressure and is single-patient-use and disposable

Pressure/settingsPressure settings are preset, continuous, fixed, and have limited or no adjustability

Canister/exudate managementTypically canister-free; exudate is absorbed into the dressing rather than collected in an external canister

Single-use battery-powered NPWT — key features

DefinitionSingle-use battery-powered NPWT devices are disposable systems with an internal disposable battery that generate negative pressure for a single-patient course

Intended use/durationDesigned for short-term, single-course therapy typically 7–14 days depending on the device

Policy Summary

PayerCigna

PolicyNegative Pressure Wound Therapy/Vacuum Assisted Closure (VAC) for Nonhealing Wounds

Policy CodePolicy 0064

Change TypeRemoval and revision of powered NPWT languageupdates to disposable device coverage

Effective DateMay 15, 2026

Next Review DateMay 15, 2027

Key ActionDo not bill or request coverage for disposable non-powered or single-use battery-powered NPWT devices (CPT 97607, 97608; HCPCS A9272) as they are not covered.

SourceLink

On This Page

Based on Kirsner, Armstrong, and other s-NPWT randomized trials.

Ankle-brachial index (ABI)

ABI between 0.7 and 1.2 indicates adequate perfusion

Chronic ulcer duration in trials

Chronic ulcer duration used in trials> 4 weeks (many chronic ulcer trials required wounds present >4 weeks)

Minimum pre-enrollment care periodWounds present despite appropriate wound care prior to entry (e.g., >30 days in some trials)

Follow-up observation windowsTrials commonly evaluated outcomes over 12–16 weeks after enrollment

Wound size eligibility examples from trials

Venous leg ulcers (VLU)Example trial range: 2–36 cm2 (Kirsner et al.)

Diabetic foot ulcers (DFU)Example trial range: 0.5–10 cm2 in one randomized trial

Other trial size boundsSome trials allowed wounds up to <100 cm2 but larger than 1 cm2

Uncontrolled hyperglycemia and related exclusions

Uncontrolled hyperglycemia exclusionGlycated hemoglobin (HbA1c) > 12% excludes participation/use in trials

Related metabolic exclusionsActive chemotherapy or end-stage renal disease on dialysis were exclusionary in trials

Infection-related exclusionsActive infection or untreated osteomyelitis were standard exclusions

Non-powered mechanical and single-use battery-powered NPWT devices — not covered for any indication
Affected codes: CPT 97607, CPT 97608, HCPCS A9272

Billing Rule

Billing and Plan-Document Guidance

When billing, providers must use the most appropriate codes as of the date of service and ensure NPWT services are accompanied by covered code(s) consistent with the plan. Claims submitted for services not accompanied by covered code(s) or for excluded device types will be denied as not covered.

Use the most appropriate CPT/HCPCS codes on the date of service
Claims for excluded device types (see not covered list) will be denied

Documentation Required

Trial Documentation Expectations

Trials and prior-authorizations routinely require thorough wound documentation. Expected documentation includes wound characteristics (size in cm2 and linear dimensions), wound duration (>30 days or >4 weeks for many chronic wound trials), wound age, wound etiology, location amenable to an airtight seal, perfusion measures (TcPO2, skin perfusion pressure, or ABI), infection status, and prior wound care interventions.

Wound size (cm2 and linear dimensions) and duration (>30 days / >4 weeks)
Perfusion: TcPO2, skin perfusion pressure, or ABI
Wound location amenable to airtight seal; infection/osteomyelitis status; prior treatments

Note

Clinical Context for Powered NPWT

Clinical context: Powered NPWT is primarily intended for chronic wounds that have not healed with standard wound care and may be used as a primary or secondary line of treatment depending on wound type. Policy revisions have clarified coverage distinctions between powered systems and non-powered or single-use disposable systems — be sure to indicate device type (powered vs non-powered/single-use) in requests.

NPWT intended for chronic, treatment-refractory wounds
Specify device type (powered rental vs non-powered/single-use) in prior authorization requests

Step Therapy

Stepwise Prior Treatments and Documentation

Some studies evaluated NPWT after other modalities such as dermal regeneration templates, skin grafts, bioengineered skin substitutes, or growth factors. Prior conservative and advanced wound therapies (e.g., compression, off-loading, dressings, grafts, bioengineered tissue) and the timing of those therapies should be documented to support stepwise use of NPWT.

Document prior therapies (e.g., compression, off-loading, DRT, grafts, bioengineered products) and timing relative to NPWT
Studies sometimes used NPWT as adjunctive therapy after grafts or DRT

Documentation Required

Common Trial Exclusion Criteria

Exclusion criteria commonly used in clinical trials should be considered when assessing appropriateness for NPWT. Typical exclusions include active infection or untreated osteomyelitis, pregnancy, known allergies to device components or wound products, wounds not amenable to a sealed dressing (anatomic location), malignancy in the wound, concurrent vasculitis or claudication, recent systemic chemotherapy or corticosteroid therapy, severe hematologic or hepatic abnormalities, and recent use of NPWT, hyperbaric oxygen, growth factors, or bioengineered tissue products within specified washout periods.

Active infection or untreated osteomyelitis — exclusion
Pregnancy; allergies to device components — exclusion
Wounds not amenable to airtight seal; malignancy; recent systemic chemo or steroids; recent NPWT, HBO, growth factors, or bioengineered products

Canister/reservoirOften canister-free or include a very small internal reservoir for low exudate volumes

Incisional negative pressure wound therapy (iNPWT)

DefinitionIncisional NPWT (iNPWT) refers to application of NPWT to primarily closed surgical incisions to prevent surgical-site complications such as infection, seroma, and dehiscence

Typical trial populationsApplied in adults undergoing clean, primarily closed incisions (examples: vascular groin incisions, high-risk colorectal reoperations)

Outcome timingTrials commonly assessed surgical-site outcomes at early (7–14 days) and 30-day time points

Single-use NPWT (s-NPWT)

DefinitionSingle-use NPWT (s-NPWT) — disposable, ultraportable NPWT systems intended for single-patient use without external canisters

Clinical rolesUsed for management of chronic ulcers or closed surgical incisions, often as a short fixed-duration course

Device characteristicsOften battery-powered or mechanical, designed for low exudate volumes and ambulatory/home settings

Single-use NPWT — characteristics and regulatory notes

CharacteristicsSingle-use/ultraportable NPWT devices are disposable, often battery-powered, with preset pressure and limited adjustability for short-term use

Regulatory pathway noteMany disposable NPWT devices have been cleared via the FDA 510(k) (Class II) pathway

Typical settingsIntended for hospital, outpatient and home use for smaller wounds or closed incisions

Powered NPWT — definition and policy note

DefinitionPowered NPWT (VAC) refers to reusable systems with electrically powered pumps that create and regulate suction and typically use an external canister for moderate-to-heavy exudate

Clinical use noteTypically used for large, deep, complex, or heavily exudating wounds and may be used for weeks to months

Policy statusPolicy statements specific to powered NPWT were removed in the 5/15/2026 annual review