HCPCS Level II › A codes A6550 Neg pres wound ther drsg setWound care set, for negative pressure wound therapy electrical pump, includes all supplies and accessories
Medicare coverage: Carrier judgment Status: active (October 2026 file) Medically Unlikely Edits (effective October 1, 2026) Practitioner: max 0 units per day (clinical), rationale: CMS Policy Outpatient hospital: max 1 units per day (clinical), rationale: Clinical: CMS Workgroup Medicare pricing for A6550 DMEPOS fee schedule, July 2026 (DME26-C) no modifier, supplies (SU): non-rural $31.08 to $31.92 in the contiguous states; $33.70 to $37.54 in AK, HI, PR and VI; rural $33.70 Physician Fee Schedule (CY 2026, RVU26D) Status X: statutory exclusion, not paid under the PFS.
Payer policies and prior authorization for A6550 16 of 16 payer prior-auth lists that name A6550 require prior authorization or set conditions: CarePlus Health Plans, Humana, UnitedHealthcare Community Plan.
Payer Plan State Prior auth Conditions Since Source CarePlus Health Plans CarePlus Health Plans FL prior auth required Jan 1, 2027 Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List Humana Humana D-SNP (FL) FL prior auth required Jan 1, 2027 1 *New prior authorization requirement 787403FL0725 FLHMQSREN Humana Dual Fully Integrated Florida Prior Authorization and Notification List Humana Humana D-SNP (IL) IL prior auth required Jan 1, 2027 Humana Dual Fully Integrated Illinois Prior Authorization and Notification List Humana Humana D-SNP (IN) IN prior auth required Jan 1, 2027 *New prior authorization requirement 814403IN0825 H4939_INHN6Z6EN_C Humana PathWays Dual Care (HMO-POS D-SNP) Indiana Prior Authorization and Notification List Humana Humana D-SNP (MI) MI prior auth required Jan 1, 2027 1 Humana Dual Highly Integrated Michigan Prior Authorization and Notification List Humana Humana D-SNP (SC) SC prior auth required Jan 1, 2027 Humana Dual Highly Integrated South Carolina Prior Authorization and Notification List Humana Humana D-SNP (VA) VA prior auth required Jan 1, 2027 Virginia Prior Authorization and Notification List Humana Humana Healthy Horizons IN prior auth required Jan 1, 2027 1 Humana Healthy Horizons® in Indiana Preauthorization and Notification List (PAL) for Indiana PathWays for Aging Please note the term prior authorization when used in this communication, is defined a Humana Humana Healthy Horizons LA prior auth required Jan 1, 2027 Humana Healthy Horizons in Louisiana Prior Authorization and Notification List To Except where noted via links on the following pages, prior authorization requests for medical services may be initiate Humana Humana Healthy Horizons OH prior auth required Jan 1, 2027 555201OH0924-B OHHMZG2EN Humana Healthy Horizons® in Ohio Prior Authorization Notification List (PAL) The following preauthorization and notification list Humana Humana Healthy Horizons SC prior auth required Jan 1, 2027 Humana Healthy Horizons in South Carolina Prior authorization and Notification List The following list describes services and medications that are commonly reviewed and may require additional clinical Humana Humana Healthy Horizons VA prior auth required Jan 1, 2027 Humana Healthy Horizons in Virginia Prior Authorization and Notification List (PAL) Humana Humana MA and D-SNP All prior auth required Jan 1, 2027 Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List Humana Humana Puerto Rico MA and Dual Medicare-Medicaid PR prior auth required Nov 3, 2025 Puerto Rico Medicare Advantage and Dual Medicare-Medicaid Plans Preauthorization and Notification List Puerto Rico Medicare Advantage and Dual Medicare-Medicaid Plan Preauthorization and Notification Humana Oak Street Health All prior auth required Oak Street Health (Humana): Prior Authorization List (PAL) Codes Under Management UnitedHealthcare Community Plan Ohio Medicaid OH prior auth required Nov 1, 2025 Prior authorization requirements for Ohio Medicaid Effective November 1, 2025 General Information This list contains prior authorization requirements for participating UnitedHealthcare Community Plan
Payer coverage policies that name A6550 A6550 appears in 20 coverage policies from Aetna, Anthem, Blue Cross & Blue Shield of Mississippi, Blue Cross Blue Shield of Massachusetts, BlueCross BlueShield of South Carolina, Capital Blue Cross, Premera Blue Cross, UnitedHealthcare.
Payer Policy Role in policy Reviewed Document Aetna Negative Pressure Wound Therapy (0334) covered if criteria are met Jun 8, 2026 payer document Aetna Surgical Devices, Dressings, and Wound Care Supplies (0526)OxyBand wound dressing not covered Aug 26, 2026 payer document Anthem Vacuum Assisted Wound Therapy in the Outpatient Setting (CG-DME-48) covered if criteria are met Aug 13, 2026 payer document Blue Cross & Blue Shield of Mississippi Negative Pressure Wound Therapy covered if criteria are met payer document Blue Cross Blue Shield of Massachusetts Negative Pressure Wound Therapy in the Outpatient Setting (543) listed, no stance payer document BlueCross BlueShield of South Carolina Negative Pressure Wound Therapy in the Outpatient Setting (CAM 10116)97608 | total wound(s) surface area greater than 50 square centimeters listed, no stance Jun 1, 2026 payer document Capital Blue Cross Negative Pressure Wound Therapy in the Outpatient Setting (MP 4.004)Procedure codes covered if criteria are met Jun 1, 2026 payer document Premera Blue Cross Negative Pressure Wound Therapy (NPWT) Devices (1.01.508) listed, no stance May 12, 2026 payer document UnitedHealthcare Negative Pressure Wound Therapy (2026T0594O) listed, no stance Jun 1, 2026 payer document UnitedHealthcare Negative Pressure Wound Therapy (CS157.M) listed, no stance Jun 1, 2026 payer document UnitedHealthcare Negative Pressure Wound Therapy (for Idaho Only) (CS157ID.D) listed, no stance Aug 1, 2026 payer document UnitedHealthcare Negative Pressure Wound Therapy (for Kansas Only) (CS157KS.02) listed, no stance Jun 1, 2026 payer document UnitedHealthcare Negative Pressure Wound Therapy (for Kentucky Only) (CS157KY.11) listed, no stance Aug 1, 2026 payer document UnitedHealthcare Negative Pressure Wound Therapy (for Nebraska Only) (CS157NE.N) listed, no stance Jun 1, 2026 payer document UnitedHealthcare Negative Pressure Wound Therapy (for New Jersey Only) (CS157NJ.I) listed, no stance Jul 1, 2026 payer document UnitedHealthcare Negative Pressure Wound Therapy (for New Mexico Only) (CS157NM.C) listed, no stance Jun 1, 2026 payer document UnitedHealthcare Negative Pressure Wound Therapy (for North Carolina Only) (CSNCT0594.07) listed, no stance Jun 1, 2026 payer document UnitedHealthcare Negative Pressure Wound Therapy (for Ohio Only) (CS157OH.E) listed, no stance Jul 1, 2026 payer document UnitedHealthcare Negative Pressure Wound Therapy (for Pennsylvania Only) (CS157PA.K) listed, no stance Jul 1, 2026 payer document UnitedHealthcare Negative Pressure Wound Therapy (for Tennessee Only) (CS157TN.K) listed, no stance Jul 1, 2026 payer document
Recent prior-auth changes Jan 1, 2027: PA added, Humana Oct 1, 2026: PA removed, Oxford Health Plans Aug 1, 2026: PA removed, HealthSpring Nov 1, 2025: PA added, uhc:pa:summary-of-changes Nov 1, 2025: PA added, UnitedHealthcare Community Plan Nov 1, 2025: PA added, uhc:pa:summary-of-changes Jul 1, 2023: PA removed, Blue Shield of California Promise Health Plan Medicaid fee-for-service Prior authorization required or conditional in IN, LA, MA, ND, NY, OH, VA, WA, WV, WY.
AZ: $37.41 (dme), effective Oct 1, 2026 IN: $26.42 (professional, Advanced Practice Nurse (85%), non-facility), effective Jan 1, 2026 KS: $25.42 (default), effective Jul 1, 2026 KY: $21.94 (dme), effective Jan 1, 2026 LA: $20.07 (dme), effective Jul 1, 2012 MA: $25.45 (dme_rates), effective Mar 1, 2026 MD: $27.00 (dme), effective Apr 1, 2026 MS: $26.96 (comprehensive), effective Jul 1, 2026 ND: $48.37 (dme), effective Aug 1, 2026 NY: $26.15 (dme), effective Jul 1, 2026 OH: $24.86 (dme), effective Jan 1, 2026 OK: $31.35 (dme), effective Jan 1, 2026 TX: $24.82 (dmepos_tos_9_e_j_l_and_r, Home Health Dme, non-facility), effective Jul 1, 2011 VA: $32.17 (dme), effective Dec 1, 2026 VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $25.33 (medical_equipment_supplies), effective Jul 1, 2026 WY: $0.00 (outpatient_hospital_apc, Children's Hospitals), effective Apr 1, 2026 From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.