Lymphedema Pumps

• Compression Pumps are not reimbursed by Medicare for the treatment of peripheral artery disease or the prevention of venous thrombosis (blood clots). 
• Lymphedema Pumps are covered for treatment of true lymphedema as a result of:
• Primary Lymphedema which is an inherited disorder that occurs on its own such as Milroy’s disease, congenital lymphedema due to lymphatic aplasia or hypoplasia, lymphedema praecox, lymphedema tarda, and similar disorders. (This is a relatively uncommon, chronic condition), or 
• Secondary lymphedema which is much more common and results from the destruction of or damage to formerly functioning lymphatic channels that may result from: • radical surgical procedures with removal of regional groups of lymph nodes (for example, after radical mastectomy), 
• radiation therapy, 
• trauma 
• obstruction caused by tumors, 
• lymphatic filariasis (typically found in developing countries) 
• Chronic Venous Insufficiency (CVI) which results in compression produced by the leakage of fluids from the venous system in the lower extremities (legs and feet), • This condition also presents with hyperpigmentation, stasis dermatitis, chronic edema and venous ulcers. 
• The incidence of lymphedema from CVI is not well established. 
• However, Medicare has established guidelines for CVI with one or more venous stasis ulcers. 
• When lymphedema extends into the chest, trunk or abdomen, a specialty pump can be considered. 
• Before you can be prescribed a pump, your physician or healthcare provider must monitor you during a minimum, four-week trial period for lymphedema and six week trial for CVI with ulcers. • During the trial your doctor or healthcare provider must document the results of other treatment options including limb elevation, regular exercise, compression bandage systems or compression garments, dietary adjustments, and the use of diuretic and similar medications as applicable. 
• Your doctor or healthcare provider should document pre and post measurements in your chart notes as each conservative treatment is evaluated. 
• If, during the trial there is any improvement using these other methods, Medicare will not approve a pump. 
• Medicare will only consider reimbursing for the pump when you have been unresponsive to the conservative treatment and there is no significant improvement over the required trial period (the most recent four or six weeks). 
• Newly established requirements of the Affordable Care Act require a specific office visit with your physician or healthcare practitioner to assess and document your need for this equipment take place and must then issue a compliant written order. 
• Depending on which product is ordered, your supplier may not be able to deliver this product to you without a written order or certificate of medical necessity from your doctor or healthcare provider. If the equipment is subject to these special rules, your supplier cannot get the documentation at a later date because if they do, Medicare can never make payment for those products to you or your supplier when a compliant order is not secured before delivery. So please be patient with your supplier while they collect the required documentation from your physician or healthcare provider.