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Medicare Coverage Info for Pneumatic Compression Devices
Medicare Coverage Info for Pneumatic Compression Devices
Centers for Medicare & Medicaid Services (CMS) has developed a medical coverage policy for Pneumatic Compression Devices, which defines the information required to determine medical necessity.  Medicare requires all of the information below before a coverage determination can be made.
 
 
Medicare Coverage Criteria Summary
Medicare requires a complete physician’s order/prescription that must include:
  • The patient’s full name and address
  • Description of the product, with the start date and length of need (in months)
  • Physician’s signature and date (no date stamps allowed)
Medicare also requires a completed Certificate of Medical Necessity, which may substitute for the physician’s order if it contains all the required elements of an order. Medicare covers pneumatic compression devices for the treatment of lymphedema or for the treatment of chronic venous insufficiency with venous stasis ulcers.

Lymphedema
The patient must have undergone a four-week trial of conservative therapy.
Chronic Venous Insufficiency with Venous Status Ulcers
The patient must have undergone a six-month trial of conservative therapy for chronic venous insufficiency of the lower extremities.  The patient’s physician must also provide information about the venous stasis ulcer(s) and the treatment thereof. 

The physician must also provide appropriate oversight of the use of the product.  For additional information on Medicare coverage of pneumatic compression devices, please consult the Medicare Coverage Policy.

This summary is not intended to be all-inclusive and should not be relied on for final coverage determinations.  Specific DMERC, Medicaid or Health Plan coverage policies should be reviewed prior to making any coverage determinations.   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 guarantee 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 local CMS contracted carrier, Medicaid carrier or other applicable payor organization with regard to specific reimbursement policies, coverage, documentation, payment and criteria.  Individual circumstances and situations may vary.