Does A6550 require prior authorization?

Yes, A6550 requires prior authorization (high confidence). Code explicitly requires prior authorization.

What is the Medicare reimbursement rate for A6550?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.00.

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`A6550`, Wound care set, for negative pressure wound therapy electrical pump, includes

HCPCS/CPT

Prior Authorization

Prior Auth Required

Code explicitly requires prior authorization (high confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

A Standard Written Order (SWO) or, where applicable, a signed Written Order Prior to Delivery (WOPD) must be received by the supplier before a claim is submitted or the DMEPOS base item is delivered.
Medical record must document wound evaluation, care, and measurements by a licensed medical professional prior to and during NPWT.

Medical record must document application of moist dressings, debridement when indicated, and evaluation/provision of adequate nutrition prior to NPWT.

For Stage 3/4 pressure ulcers document turning/positioning, use of group 2 or 3 support surface for posterior trunk/pelvis, and moisture/incontinence management prior to NPWT.

For neuropathic ulcers document enrollment in a comprehensive diabetic management program and evidence of pressure offloading for foot ulcers prior to NPWT.

For venous insufficiency ulcers document consistent use of compression bandages/garments and instructions to elevate legs and ambulate prior to NPWT.

Key Coverage Criteria

For Stage 3 or 4 pressure ulcers, beneficiary must have been appropriately turned and positioned prior to NPWT.
NPWT pump (E2402) and supplies (A6550, A7000) are covered in the home setting for beneficiaries with a chronic (>=30 days) Stage 3 or 4 pressure ulcer, neuropathic (e.g., diabetic) ulcer, venous or arterial insufficiency ulcer, or a chronic ulcer of mixed etiology.
Coverage requires that a complete wound therapy program has been tried or considered and ruled out prior to application of NPWT.
General wound-therapy measures that must be addressed prior to NPWT include documentation of wound evaluation and measurements by a licensed medical professional.
General wound-therapy measures include application of dressings to maintain a moist wound environment prior to NPWT.
General wound-therapy measures include debridement of necrotic tissue when present prior to NPWT.

13 Active Policies

ANTHEM-CG-DME-48, Vacuum Assisted Wound Therapy in the Outpatient Setting

EVICORE-HPLAN-CIGNA_MEDICARE-268F28B96146, Cigna Medicare Advantage Durable Medical Equipment Code List - Effective 01/01/2025

L33821, Negative Pressure Wound Therapy Pumps

UHC-POL-negative-pressure-wound-therapy, Negative Pressure Wound Therapy

AETNA-CPB-0334, Negative Pressure Wound Therapy

AETNA-CPB-0526, Surgical Devices, Dressings, and Wound Care Supplies

BCBSIL-DME101.036, Negative Pressure Wound Therapy in the Outpatient Setting

BCBSMT-DME101.036, Negative Pressure Wound Therapy in the Outpatient Setting

BCBSNM-DME101.036, Negative Pressure Wound Therapy in the Outpatient Setting

BCBSOK-DME101.036, Negative Pressure Wound Therapy in the Outpatient Setting

REGENCE-DME42, Negative Pressure Wound Therapy in the Outpatient Setting

UMR-POL-UMR-negative-pressure-wound-therapy, Negative Pressure Wound Therapy

SUREST-POL-SUREST-negative-pressure-wound-therapy, Negative Pressure Wound Therapy

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A6550, Wound care set, for negative pressure wound therapy electrical pump, includes