CommercialPrior AuthHigh impact
Negative Pressure Wound Therapy
Blue Cross & Blue Shield of Mississippi·MS · Wound Care, General Surgery, Plastic Surgery +4 more·Medical Policy
We identified it
Jun 20, 2026
Summary
Blue Cross Blue Shield of Mississippi updated their Negative Pressure Wound Therapy policy requiring prior authorization for all NPWT devices, with specific medical necessity criteria for powered systems and declaring single-use systems investigational. Prior authorization requests must be submitted by Home Health Agencies, Discharging Hospitals, or Prescribing Providers only - DME companies cannot submit requests.
Action Required
Immediately: Billing team must obtain prior authorization before providing any NPWT services for BCBS Mississippi members. Update billing system to flag NPWT cases for prior auth. Ensure prior authorization requests are submitted by qualified providers (Home Health Agency, Hospital, or Prescribing Provider) using the Home Health & Hospice Authorization Request form - DME companies cannot submit requests. Document medical necessity including failed standard wound care, wound characteristics, and comprehensive wound care program. Claims will be denied without proper prior authorization.