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Lymphedema Pumps

Medicare covers lymphedema pumps, or pneumatic compression devices, for patients who have severe swelling due to lack of drainage of lymphatic fluid. These devices are also covered for patients with severe circulation problems or ulcers.

Lymphedema Pumps are covered as a treatment for lymphedema if

• A patient has had lymphedema since childhood or adolescence OR
• A patient has had radical cancer surgery or radiation for cancer that interrupted normal lymphatic draining of the extremity OR
• A patient has a malignant tumor with obstruction of the lymphatic drainage of an extremity

Medicare will not cover pneumatic compression devices as an initial therapy for lymphedema in the home setting. A patient must first undergo a four-week trial of conservative therapy, which includes the use of an appropriate compression garment, exercise and elevation. This garment does not need to be custom-fabricated; however, it does need to be a graduated compression stocking/sleeve. A pneumatic compression device is covered if a physician determines after such a trial that there has been no significant improvement, or if significant symptoms remain.

Lymphedema Pumps may also be covered if a patient has chronic venous insufficiency with venous stasis ulcers. If for venous stasis ulcers, additional documentation must be provided and documentation has to be provided that the physician has seen the patient regularly over the past six months and treated the ulcers with other treatment options such as medication, limb elevation and compression garments. If at the end of the trial the stasis ulcers are still present, a lymphedema pump can be considered.

The doctor must then document an initial treatment with a pump and establish that the treatment can be tolerated, that there is a caregiver available to assist with the treatment in the home, and then the doctor must prescribe the pressures, frequency, and duration of prescribed use.

An order (prescription) must be on file with the supplier. It must be signed and dated by the treating doctor. A Certificate of Medical Necessity must be completed, signed, and dated by the treating doctor.