MLN Product (Revised); Title: Provider Compliance Tips for Negative Pressure Wound Therapy
This revised Product comprises Subregulatory Guidance for Durable Medical Equipment (DME) Suppliers of NPWT equipment and physicians who order and supervise NPWT, and its content is based on publically available content within the 2020 Medicare Fee-for-Service Supplemental Improper Payment Data at https://www.cms.gov/files/document/2020-medicare-fee-service-supplemental-improper-payment-data.pdf, the Medicare Coverage Database, Local Coverage Determination (LCD): Oral Cancer Drugs (L33826) at https://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=33826&ver=11&TAId=95&articleId=50905&CoverageSelection=Both&ArticleType=All&PolicyType=Final&s=Ohio&KeyWord=drug&KeyWordLookUp=Title&KeyWordSearchType=And&bc=gAAAACAAAAAAAA%3d%3d, Local Coverage Article: Negative Pressure Would Therapy Pumps – Policy Article (A52511) at https://www.cms.gov/medicare-coverage-database/details/article-details.aspx?articleId=52511&ver=12&CoverageSelection=Local&ArticleType=All&PolicyType=Final&s=All&KeyWord=negative%2Bpressure%2Bwound&KeyWordLookUp=Title&KeyWordSearchType=And&from2=search.asp&bc=gAAAACAAAAAAAA%3d%3d, and the Medicare Program Integrity Manual, Chapter 3- Verifying Potential Errors and Taking Corrective Action at https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/pim83c03.pdf. CMS policy or operation subject matter experts also reviewed/cleared this product. This Product educates providers on coverage and proper billing of Negative Pressure Wound Therapy (NPWT). In 2020, Medicare Fee-for-Service reported an improper payment rate of 36.3% for NPWT, representing a projected improper payment amount of $37.9 million. NPWT is the application of sub-atmospheric pressure to a wound to remove exudate and debris from the wound(s). NPWT is delivered to a qualified wound through an integrated system.
Revisions to this Product include the following content updates:
• Updated the improper payment rate for Negative Pressure Wound Therapy (NPWT) for the 2020 reporting period (page 2)
The previous version of this Product is available to the public and currently posted on the CMS website at https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/ProviderComplianceTipsforNegativePressureWoundTherapy-ICN909484.pdf
Final
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: May 10, 2021
DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.