Are Lymphedema Pumps Covered By Medicare?
A pneumatic compression device (PCD) consists of an inflatable garment for the arm or leg & an electrical pneumatic pump that fills the garment with compressed air.
Pneumatic compression device (PCD) is used for the treatment of lymphedema or chronic venous insufficiency with venous stasis ulcers. This device helps to move the fluid through the lymphatic system without accumulation & return it to the blood stream.
The goal of treatment for lymphedema is preventing further accumulation of lymph fluid & injury to the affected limb. First line therapy should be initiated before proceeding into using a pneumatic pump. Decongestive lymphatic therapy is the first line treatment for lymphedema. Pneumatic compression device is one of the methods of decongestive lymphatic therapy. There are other treatment modalities like compression bandages & garments, exercises, special massage therapy. Using more than one modality of treatment (multi-modal) is effective than single modality therapy.
Are Lymphedema Pumps Covered By Medicare?
Pneumatic compression device (PCD) coverage by Medicare will be provided for lymphedema when it is prescribed by a doctor for medical reason. . Coverage decisions will be made in accordance with:
- The Centers for Medicare & Medicaid Services (CMS) national coverage decisions
- General coverage guidelines included in original Medicare manuals unless superseded by operational policy letters or regulations; &
- Written coverage decisions of local Medicare carriers & intermediaries with jurisdiction for claims in the geographic area in which services are covered.
Indications For Coverage
Pneumatic compression device (PCD) are considered as an appropriate treatment for refractory primary & secondary lymphedema, & chronic venous insufficiency with venous stasis ulcers
Pneumatic compression pumps are only covered for purchase when the patient has completed a successful trial. For the trial, you must meet criteria: A (1 & 2) or B.
A 4 week trial rental will be covered for Primary & Secondary Lymphedema if:
- The patient have to undergo a four-week attempt of conservative treatment that must include use of an appropriate compression bandage system or compression garment, & elevation of the limb; &
- The treating doctor makes sure that there has been no significant improvement in patient’s condition or if symptoms still remain even after the conservative therapy; OR
A 4 week trial rental will be covered for Venous Stasis Ulcers if:
The patient has edema of the affected lower extremity, one or more venous stasis ulcer(s) which have failed to heal after a six-month trial of conservative treatment including a compression bandage system, appropriate dressing for the wound, exercise, & limb elevation.
Once the trials are completed, purchase is covered once the additional criteria below are met:
- The four-week rental trial of the pneumatic compression device was accomplished, &
- The patient can tolerate the device, &
- In the provider’s opinion there has been an appropriate clinical response, &
- The member can properly manage the device.
When Coverage Will Not Be Approved
- For indications other than mentioned above.
- When the medical guidelines shown above are not met.
- Appliances used for pneumatic compression of the chest or trunk (E0656 & E0657) will be denied as not medically necessary.
- Pneumatic compression device (PCD) E0675 used in the treatment of peripheral arterial disease is not reasonable & necessary & therefore not covered.
Pneumatic compression pumps will be covered by Medicare for the treatment of lymphedema & chronic venous insufficiency with venous stasis ulcers. Pneumatic compression pumps are only covered for purchase when the patient has completed a successful trial. For the trial, you must meet criteria: A (1 & 2) or B. once the trials are completed, purchase is covered once the additional criteria are met. The prescribing doctor must send Medicare a written request for approval, called a Certificate of Medical Necessity. The equipment must be rented or purchased from a Medicare-certified medical equipment supplier.