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The rules say that plans must pay for a medical service or item if regular Medicare would pay for it in this case. 
You can find this rule at 42 Code of Federal Regulations (CFR) Section 422.101. 
 
The rules say that a Negative Pressure Wound Therapy pump (E2402) and supplies (A6550, A7000) are 
covered when either criterion A or B is met: 
 
    A. Ulcers and Wounds in the Home Setting: 
 
    The beneficiary has a chronic Stage III or IV pressure ulcer (see Appendices Section), neuropathic (for 
example, diabetic) ulcer, venous or arterial insufficiency ulcer, or a chronic (being present for at least 30 days) 
ulcer of mixed etiology. A complete wound therapy program described by criterion 1 and criteria 2, 3, or 4, as 
applicable depending on the type of wound, must have been tried or considered and ruled out prior to 
application of NPWT. 
 
            1. For all ulcers or wounds, the following components of a wound therapy program must include a 
minimum of all of the following general measures, which should either be addressed, applied, or considered 
and ruled out prior to application of NPWT: 
 
                a. Documentation in the beneficiary's medical record of evaluation, care, and wound measurements 
by a licensed medical professional, and 
                b. Application of dressings to maintain a moist wound environment, and 
                c. Debridement of necrotic tissue if present, and 
                d. Evaluation of and provision for adequate nutritional status 
 
            2. For Stage III or IV pressure ulcers: 
 
                a. The beneficiary has been appropriately turned and positioned, and 
                b. The beneficiary has used a group 2 or 3 support surface for pressure ulcers on the posterior trunk 
or pelvis (see LCD on support surfaces), and 
                c. The beneficiary's moisture and incontinence have been appropriately managed 
 
           3. For neuropathic (for example, diabetic) ulcers: 
 
                a. The beneficiary has been on a comprehensive diabetic management program, and 
               b. Reduction in pressure on a foot ulcer has been accomplished with appropriate modalities 
 
           4. For venous insufficiency ulcers: 
              
                a. Compression bandages and/or garments have been consistently applied, and 
                b. Leg elevation and ambulation have been encouraged 
 
    B. Ulcers and Wounds Encountered in an Inpatient Setting: 
 
            1. An ulcer or wound (described under A above) is encountered in the inpatient setting and, after wound 
treatments described under A-1 through A-4 have been tried or considered and ruled out, NPWT is initiated 
because it is considered in the judgment of the treating practitioner, the best available treatment option. 
           2. The beneficiary has complications of a surgically created wound (for example, dehiscence) or a 
traumatic wound (for example, pre-operative flap or graft) where there is documentation of the medical 
necessity for accelerated formation of granulation tissue which cannot be achieved by other available topical 
wound treatments (for example, other conditions of the beneficiary that will not allow for healing times 
achievable with other topical wound treatments). 
 
In either situation B-1 or B-2, NPWT will be covered when treatment is ordered to continue beyond discharge 
to the home setting. 
 
If criterion A or B above is not met, the NPWT pump and supplies will be denied as not reasonable and 
necessary. 
 
NPWT pumps (E2402) must be capable of accommodating more than one wound dressing set for multiple 
wounds on a beneficiary. Therefore, more than one E2402 billed per beneficiary for the same time period will 
be denied as not reasonable and necessary. 
 
Coverage is provided up to a maximum of 15 dressing kits (A6550) per wound per month. 
 
Coverage is provided up to a maximum of 10 canister sets (A7000) per month unless there is documentation 
evidencing a large volume of drainage (greater than 90 ml of exudate per day). 
 
For high volume exudative wounds, a stationary pump with the largest capacity canister must be used. 
 
When billing for quantities of canisters greater than those described in the policy as the usual maximum 
amounts, there must be clear and explicit information in the medical record that justifies the additional 
quantities. 
 
You can find this information in Medicare's Local Coverage Determination (LCD): Negative Pressure Wound 
Therapy Pumps (L33821). 
 
If you want to read these Medicare rules, you can go to this website www.medicareappeal.com.