CPAP Documentation & Guidelines | Oxygen Documentation & Guidelines
Lymphedema Pump Documentation & Guidelines| Respiratory Review
Medicare Dear Physician Letters | Medicare Policies | Quick Script
Lymphedema Pumps & Segmental Gradient Garments:
Medicare covers pneumatic compression devices (lymphedema pumps) 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.
Medicare also covers pneumatic compression devices in the home setting for the treatment of chronic venous insufficiency (CVI) of the lower extremities only if the patient has one or more venous statis ulcers which have failed to heal after a six month trial of conservative therapy* directed by the physician.
*Conservative Therapy Includes:
- Use of an appropriate compression bandage system or compression garment;
- Exercise; and
- Elevation of the limb.
If conservative therapy is being used to treat CVI, then the "appropriate dressings for the wound" would also need to be documented, along with the above.
Documentation Needed for Insurance Coverage:
1. Patient notes which state the following:
a. Patient's diagnosis & prognosis;
b. Symptoms & objective findings, including measurements which establish the severity of the condition;
c. Reason that the device is required, including treatments that have been tried and failed. Includes:
- A four-week trial of conservative therapy for lymphedema; or
- A six-month trial of conservative therapy for CVI; &
- "There has been no significant improvement" in symptoms or "significant symptoms remain" after the trial.
d. And, clinical response to initial treatment with the device. [Clinical response includes the changes in pre-treatment measures, ability to tolerate the treatment session and parameters, and ability of the patient or caregiver to apply the device for continued use in the home.]
2. Prescription for the pump, including garment type (i.e. arm, half-leg, or full-leg), pressure, and length of therapy session.
3. Patient's insurance & demographics.
Please fax the information to 716.972.0219. If you have any questions, don't hesitate to call us at 716.667.9600. Click here to download the above information in PDF format.
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