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Payers: V.A.C.® Therapy: V.A.C.® Therapy Managed Care Reimbursement Information*
V.A.C.® Therapy Managed Care Reimbursement Information*
Many managed care companies throughout the United States have contracted with KCI to provide access to their members of V.A.C.® Therapy.  Currently, over 200 million managed care covered lives have access to V.A.C.® Therapy. 
Ready to Order V.A.C.® Therapy?
Get the V.A.C.® Therapy Insurance Auth. Form.
 
 
Initial Managed Care Coverage Requirements
KCI collects the following information for managed care plans before a coverage determination can be made.  Most managed care companies follow Medicare's criteria for determining medical necessity.  Please check with the individual health plan to review their specific V.A.C.® Therapy coverage criteria.

Complete Physician's Order/Prescription

  1. The patient's full name and address
  2. Description of V.A.C.® Therapy, with the start date and length of need (in months)
  3. Frequency of dressing changes and quantity of supplies (Medicare allows up to 15 dressings and 10 canisters per month.)
  4. Physician's signature and date (no stamps allowed)
  5. Diagnosis
  6. Goal of therapy

When a patient qualifies for managed care coverage and payment, managed care plans reimburse KCI directly for V.A.C.® Therapy and the related canisters and dressings. KCI submits claims directly to the plan.

Most V.A.C.® Therapy Medical Policies allow for up to 15 dressing kits per wound per month and 10 canisters per month. Additional dressing kits may be used and reimbursed by the managed care plan if documentation of the medical need is provided to KCI. If there is no justified medical necessity for excess dressings, the patient will be requested to complete a waiver of liability (known as an Advance Beneficiary Notice). This document notifies the patient of his or her financial responsibility for these excess dressings.
Reauthorizing V.A.C.® Therapy
Initial certification for V.A.C.® Therapy can vary for managed care patients from 14 to 30 days of therapy.  Most payors require the submission of a report showing the effectiveness of V.A.C.® Therapy and justification for another reauthorization cycle.  Complete sections one and two of the form answering questions by checking "yes" or "no".  Also please obtain a recent record of the patient's wound measurements.  When complete, please print your name, title, employer and phone number; sign and date.  Fax to KCI at 1-888-245-2295. 
Discontinuing V.A.C.® Therapy
When the physician discontinues V.A.C.® Therapy, call KCI at 1-800-275-4524 within 24 hours of discontinuation.  Inform the KCI Customer Service Representative that V.A.C.® Therapy has been discontinued and you need to arrange for a pick-up of the V.A.C.® Therapy unit and unopened supplies. 

Be prepared to give the patient's name, phone number and the date therapy ended.  In addition, please complete the Discharge from Negative Pressure Wound Therapy form.  Fax the completed form to KCI at 1-888-245-2295. 

If the V.A.C.® Therapy unit has not been picked up after two days, call KCI at 1-800-275-4524. 
Claims Modification Policy
Due to the complexity of the claims administration process, managed care organizations and private insurance payers must participate as required in this policy for the successful administration and final resolution of modifications to claims.  Please click Claims Modification Policy to see the policy.
Medicare Advantage Information
The managed healthcare plan that provides medical benefits through Medicare Advantage is obligated to provide the patient with the same level of benefits that would be available under the original Medicare plan for those items of DME for which a National Coverage Determination (NCD) exists. NPWT is covered under a Local Coverage Determination (LCD), therefore each individual Medicare Advantage plan can decide whether it will reimburse for NPWT.
* This summary is not intended to be all-inclusive and should not be relied on for final coverage determinations.  The complete V.A.C.® Therapy policy can be accessed by contacting each health plan.  Additional criteria may be required for coverage of eligible patients depending on individual circumstances.  The information contained in this website is provided for informational purposes only and represents no statement, promise or guarentee by KCI concerning the levels of reimbursement, payment, calculations, eligibility, charge or that these policies and codes will be appropriate for specific services or products provided or that reimbursement will be made.  Information is current as of the date of publication and is subject to change at anytime.  KCI recommends that you consult your health plan with regard to specific reimbursement policies, coverage, documentation, payment and criteria.  Individual situations and situations may vary.