K0746 Absorp drg >48 suc pump

Absorptive wound dressing for use with suction pump, home model, portable, pad size greater than 48 square inches

Medically Unlikely Edits (effective October 1, 2026)

Payer policies and prior authorization for K0746

1 of 1 payer prior-auth lists that name K0746 require prior authorization or set conditions: Blue Shield of California Promise Health Plan.

PayerPlanStatePrior authConditionsSinceSource
Blue Shield of California Promise Health PlanPromise Health Plan Medi-CalCAprior auth requiredSep 1, 2026Medi-Cal Prior Authorization List

Payer coverage policies that name K0746

K0746 appears in 7 coverage policies from Aetna, Blue Cross & Blue Shield of Mississippi, Capital Blue Cross, Premera Blue Cross, Regence.

PayerPolicyRole in policyReviewedDocument
AetnaNegative Pressure Wound Therapy (0334)covered if criteria are metJun 8, 2026payer document
AetnaSuction Pumps (0503)covered if criteria are metJul 2, 2026payer document
AetnaSurgical Devices, Dressings, and Wound Care Supplies (0526)
OxyBand wound dressing		not coveredAug 26, 2026payer document
Blue Cross & Blue Shield of MississippiNegative Pressure Wound Therapyunproven / investigationalpayer document
Capital Blue CrossNegative Pressure Wound Therapy in the Outpatient Setting (MP 4.004)
Procedure codes		covered if criteria are metJun 1, 2026payer document
Premera Blue CrossNegative Pressure Wound Therapy (NPWT) Devices (1.01.508)listed, no stanceMay 12, 2026payer document
RegenceNegative Pressure Wound Therapy in the Outpatient Setting (Durable Medical Equipment 42)listed, no stanceFeb 1, 2026payer document

Medicaid fee-for-service

Prior authorization required or conditional in IN, LA, OH.

  • 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.