CurrentWest Virginia Bureau for Medical Services (Department of Human Services)Policy N/A

Wound Care — Negative Pressure Wound Therapy (NPWT) and Biologics Coverage

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Defines West Virginia Medicaid coverage, prior authorization, medical necessity criteria, covered wound biologics and devices, and non-covered wound modalities for enrolled providers and beneficiaries.

Policy Summary

PayerWest Virginia Bureau for Medical Services (Department of Human Services)

PolicyWound Care — NPWT, biologics, and coverage criteria

Policy CodePolicy N/A

Change TypeMaterial language updates to Background and NPWT policy

Effective DateJul 1, 2023

Last ReviewJul 1, 2023

Next Review DateN/A

Key ActionSubmit prior authorization with a Plan of Care for NPWT pumps and supplies for Stage 3–4 wounds and document monthly wound measurements while on therapy.

SourceLink

POLICY UPDATE CHANGES

Language was added to the Background section and policy was updated to reflect Negative Pressure Wound Therapy.

Roman numerals were changed to Arabic numerals in stage naming to reduce confusion.

A duplicate non-covered item (Epicel) was removed from the non-covered list.

Stage 3-4NPWT prior authorization required for wound stages

30 daysMinimum wound duration in home setting before NPWT eligibility

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