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Issue Number - Name
0131-Pneumatic Compression Device
Review Type
Complex
Claim Type
DME by supplier, DME by Physician
Region and State
JA, JB, JC, JD
Date Approved
2019-01-08

Description

Pneumatic Compression Devices, HCPCS Codes E0651 and E0652, may have been provided to patients where all Medicare coverage criteria were not met.  This review will determine if the pneumatic compression device is reasonable and necessary for the patient’s condition based on the documentation in the medical record. Claims that do not meet the indications of coverage and/or medical necessity will be denied.

Affected Codes

E0651- Pneumatic compressor, segmental home model without calibrated gradient pressure
E0652- Pneumatic compressor, segmental home model with calibrated gradient pressure

Applicable Policy References

Social Security Act: Section 1833(e)
Social Security Act: Section 1862(a)(1)(A)
42 CFR, Sections 405.980 (b)&(c), Section 405.986
42 CFR, Section 410.38 (g)(3)
42 CFR, Section 410.38 (g)(4)
42 CFR, Section 424.57 (12)
CMS Pub. 100-02, Medicare Benefit Policy Manual, Chapter 15, Section 110, Durable Medical Equipment
CMS Pub. 100-03, Medicare National Coverage Determination Manual, Chapter 1, Part 4, Section 280.6, Pneumatic Compression  Devices
CMS Pub. 100-04, Medicare Claims Processing Manual, Chapter 30 Section 50.13.4, Supplier’s Right to Recovery Resalable Items for Which Refund Has Been Made
CMS Pub. 100-08, Medicare Program Integrity Manual, Chapter 4, Section 4.26, Supplier Proof of Delivery Documentation Requirements
CMS Pub. 100-08, Medicare Program Integrity Manual, Chapter 5, Section 5.2.4 – 5.2.8, 5.7, 5.8, and 5.9