Negative Pressure Wound Therapy/Vacuum Assisted Closure (VAC) for Nonhealing Wounds - (0064) — MM 0064 | CIGNA Coverage Update

Cigna modified MM 0064 for negative pressure wound therapy (NPWT), effective September 26, 2025. Here's what billing teams need to do.

Cigna Healthcare updated its NPWT/vacuum-assisted closure (VAC) coverage policy under MM 0064 Cigna system, effective September 26, 2025. This change covers CPT codes 97605, 97606, 97607, and 97608, along with HCPCS codes A6550, A9272, and E2402. If your practice bills NPWT across inpatient, outpatient, long-term care, or home care settings, this update applies to you.

Quick-Reference Table

Cigna NPWT Coverage Criteria and Medical Necessity Requirements 2025

The Cigna NPWT coverage policy under MM 0064 covers vacuum-assisted closure for nonhealing wounds across multiple care settings. That includes hospitals, clinics, long-term care facilities, and home care. The policy distinguishes between device types — portable vs. fixed, electrically powered vs. mechanically powered, and reusable vs. disposable — and that distinction drives which codes apply.

Medical necessity is the threshold question here. Cigna requires clinical documentation that supports NPWT as appropriate for the specific wound being treated. That means your records need to show why standard wound care failed or isn't appropriate, and why NPWT is the right next step.

The policy groups all seven codes — CPT 97605, 97606, 97607, 97608 and HCPCS A6550, A9272, E2402 — under "Considered Medically Necessary." That's the right label, but it doesn't mean automatic reimbursement. Medical necessity still has to be established per claim. Document accordingly.

Prior authorization requirements for NPWT vary by Cigna plan. Check the member's specific plan before you schedule or order the device. Assuming auth isn't required is how you end up with a claim denial that's hard to overturn.

Coverage Indications at a Glance

Cigna NPWT Billing Guidelines and Action Items 2025

The real issue with NPWT billing is code selection. You have four CPT codes and three HCPCS codes in play, and picking the wrong one based on device type or wound size creates a denial that documentation alone won't fix.

Here's what your billing team should do before the September 26, 2025 effective date:

CPT, HCPCS, and ICD-10 Codes for Negative Pressure Wound Therapy Under MM 0064

Covered CPT Codes (When Medical Necessity Criteria Are Met)

Covered HCPCS Codes (When Medical Necessity Criteria Are Met)

No ICD-10-CM codes are specified in this policy. The MM 0064 Cigna policy does not enumerate specific diagnosis codes. Your medical necessity documentation must support the wound diagnosis, but the policy doesn't restrict coverage to a defined ICD-10 list. That's actually useful — it gives you flexibility, but it also means Cigna reserves the right to question any diagnosis that doesn't clearly support NPWT.

A Note on Device Type — This Is Where Claims Break Down

The split between DME-based and disposable NPWT is the biggest practical issue in this policy. CPT 97605 and 97606 go with electrically powered durable medical equipment — the kind with a reusable pump, billed under HCPCS E2402. CPT 97607 and 97608 go with disposable, non-powered devices — billed under HCPCS A9272.

These are not interchangeable. Billing CPT 97605 when you used a disposable device isn't a technicality — it's the wrong code. The same goes in reverse.

If your facility uses both device types depending on care setting, your charge capture workflow needs to branch at the point of device selection. Build that logic in now, before the updated Cigna NPWT billing guidelines are live on September 26, 2025.