`A9272` Disp wound suct, drsg/access

Wound suction, disposable, includes dressing, all accessories and components, any type, each

Medicare coverage: Special coverage instructions apply
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 0 units per day (clinical), rationale: CMS Policy
DME supplier: max 0 units per day (clinical), rationale: CMS Policy

Medicare pricing for A9272

Physician Fee Schedule (CY 2026, RVU26D)

Status X: statutory exclusion, not paid under the PFS.

Payer policies and prior authorization for A9272

1 of 1 payer prior-auth lists that name A9272 require prior authorization or set conditions: Blue Cross and Blue Shield of Texas.

Payer	Plan	State	Prior auth	Conditions	Since	Source
Blue Cross and Blue Shield of Texas	Texas PA exemption (gold card), outpatient, fully insured	TX	prior auth required	Gold-card exemption available	Mar 1, 2023	BCBSTX Outpatient Prior Authorization Exemption Clinical Guidelines (max units, PA exempt date range)

Payer coverage policies that name A9272

A9272 appears in 20 coverage policies from Aetna, Anthem, Blue Cross & Blue Shield of Mississippi, Blue Cross & Blue Shield of Rhode Island, Blue Cross Blue Shield of Massachusetts, Capital Blue Cross, Cigna, Premera Blue Cross, Regence, 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	Suction Pumps (0503)	covered if criteria are met	Jul 2, 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	unproven / investigational		payer document
Blue Cross & Blue Shield of Rhode Island	Disposable Negative Pressure Wound Therapy	not covered	Jul 1, 2026	payer document
Blue Cross Blue Shield of Massachusetts	Negative Pressure Wound Therapy in the Outpatient Setting (543)	unproven / investigational		payer document
Capital Blue Cross	Negative Pressure Wound Therapy in the Outpatient Setting (MP 4.004) Procedure codes	unproven / investigational	Jun 1, 2026	payer document
Cigna	Negative Pressure Wound Therapy/Vacuum Assisted Closure (VAC) for Nonhealing Wounds (0064)	not covered	May 15, 2026	payer document
Premera Blue Cross	Negative Pressure Wound Therapy (NPWT) Devices (1.01.508)	listed, no stance	May 12, 2026	payer document
Regence	Negative Pressure Wound Therapy in the Outpatient Setting (Durable Medical Equipment 42)	listed, no stance	Feb 1, 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 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 Mexico Only) (CS157NM.C)	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

Oct 1, 2026: PA removed, Oxford Health Plans

Medicaid fee-for-service

Prior authorization required or conditional in IN, OH.

TX: $345.68 (dmepos_tos_9_e_j_l_and_r, Home Health Dme, non-facility), effective Apr 1, 2017
VT: $0.00 (outpatient_hospital_opps), effective Feb 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.

A9272 Disp wound suct, drsg/access