Medicare AdvantageCoverageMedium impact
Negative Pressure Wound Therapy - Medicare Advantage (Revised)
Humana·Wound Care, General Surgery, Plastic Surgery +2 more·Medicare Advantage
Effective date
May 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage has updated their Negative Pressure Wound Therapy policy effective May 1, 2026, establishing coverage criteria and billing guidelines for NPWT services. The policy references multiple CMS Local Coverage Determinations and specifies coverage requirements for both durable and disposable NPWT systems.
Action Required
Before May 1, 2026: Billing team must review and align NPWT billing practices with the referenced CMS Local Coverage Determinations (L33821, L33612, L35125) based on geographic jurisdiction. Update billing system to ensure proper code selection between durable medical equipment codes (97605-97606) and disposable equipment codes (97607-97608) based on wound surface area (≤50 sq cm vs >50 sq cm). Verify coverage criteria compliance for all NPWT services to prevent claim denials.