Medicare's Criteria for Lymphedema Pumps
Pneumatic compression devices/Lymphedema Pumps are only covered for the treatment of lymphedema or for the treatment of chronic venous insufficiency with venous stasis ulcers. If the coverage criteria below are not met, the devices will be denied as they will not be medically necessary.
LYMPHEDEMA: The swelling of subcutaneous tissues due to the accumulation of excessive lymph fluid. The accumulation of lymph fluid results from impairment to the normal clearing function of the lymphatic system and/or from an
excessive production of lymph. Lymphedema is divided into two broad, uncommon, chronic conditions which may be due to causes such as Milroy's Disease or congenital anomalies. Secondary lymphedema, which is much more common, results from the destruction of or damage to formerly functioning lymphatic channels, such as radical surgical procedures with
removal of regional groups of lymph nodes (for example, after radical mastectomy), post-radiation fibrosis, and spread of malignant tumors to regional lymph nodes with lymphatic obstruction, among other causes.
The trial of conservative therapy must include use of an appropriate
compression bandage system or compression garment, exercise, and
elevation of the limb. The garment may be prefabricated or
custom-fabricated but must provide adequate graduated compression.
Pneumatic compression devices are covered in the home setting for the
treatment of lymphedema if the patient has undergone a four-week trial
of conservative therapy and the treating physician determines that there
has been no significant improvement or if significant symptoms remain
after the trial.
CHRONIC VENOUS INSUFFICIENCY WITH VENOUS STASIS ULCERS: Chronic venous insufficiency (CVI) of the lower extremities is a condition caused by abnormalities of the venous wall and valves, leading to obstruction or reflux of blood flow in the veins. Signs of CVI include hyperpigmentation, stasis dermatitis, chronic edema, and venous ulcers.Pneumatic compression devices are covered in the home setting for the
treatment of CVI of the lower extremities only if the patient has one
or more venous stasis ulcers which have failed to heal after a six
month trial of conservative therapy directed by the treating physician.
The trial of conservative therapy must include a compression bandage
system or compression garment, appropriate dressings for the wound, exercise, and elevation of the limb.
Yes, you have read it correctly. Medicare has made obtaining coverage for this product almost impossible.