Reimbursement Changes for Disposable Negative Pressure Wound Therapy

Tuesday, July 2, 2024

Disposable Negative Pressure Wound Therapy (dNPWT), also known as topical negative pressure and vacuum-assisted closure, uses a localized vacuum for rapid wound healing. The goal of dNPWT is to create a controlled, closed wound amenable to surgical closure, grafting or healing. Effective retroactively to Jan. 1, 2024, TRICARE’s home health agency (HHA) reimbursement guidelines for dNPWT have changed.

HCPCS Code A9272

Under the new reimbursement guidelines, the separate payment for dNPWT devices, when furnished to beneficiaries who are under a home health plan of care, is available under HCPCS A9272 (or alternative codes if modified by Medicare). Providers should report HCPCS code A9272 on type of bill (TOB) 32X.

Nursing or Therapy Services No Longer Included in dNPWT Device Payments

Effective for calendar year 2024, TRICARE will no longer include payment for nursing or therapy services in the payment for dNPWT devices. Payment for such nursing or therapy services is now included under the Home Health Agency Prospective Payment System (HHA PPS). For dates of service on or after Jan. 1, 2024, providers should no longer submit a TOB 34X for nursing or therapy services for applicable dNPWT devices. 

For more information on dNPWT coverage and changes, refer to TRICARE Reimbursement Manual, Chapter 12, Section 1.

Visit our Home Health Billing page for more information.