Pneumatic Compression Devices & Accessories

Affected Providers

Treating practitioners and DME suppliers who bill for pneumatic compression devices and accessories.

Background

According to the 2024 Medicare Fee-for-Service Supplemental Improper Payment Data, the improper payment rate for pneumatic compression devices is 61.5%, with a projected improper payment amount of $37.7 million.

We cover pneumatic compression devices under the DME benefit. You must meet the provisions in National Coverage Determination (NCD): Pneumatic Compression Devices (280.6). 

Pneumatic compression devices include both an inflatable garment for a patient’s arm or leg and an electrical pneumatic pump that fills the garment with compressed air. The garment is intermittently inflated and deflated with cycle times and pressures that vary between devices.

Denial Reasons

Insufficient documentation accounted for 62.9% of improper payments for pneumatic compression devices during the 2024 reporting period, while medical necessity (37.1%) also caused improper payments.

Preventing Denials

We cover pneumatic compression devices only when a physician prescribes them and oversees their use. Physician oversight is demonstrated by:

• Evaluating the patient’s condition to determine whether the device is medically necessary
• Assuring suitable instruction to the patient on how to operate the machine
• A treatment plan defining the pressure to be used, frequency, and duration of use
• Ongoing monitoring of use and response to treatment
• The physician’s medical necessity determination must include:
• The patient’s diagnosis and prognosis
• Symptoms and objective findings, including measurements that show the condition’s severity
• The reason the patient needs the device, including the treatments that have been tried and failed
• The clinical response to initial treatment with the device that should include:
  • Change in pre-treatment measurements
  • Ability to tolerate the treatment session and parameters
  • Ability of the patient (or caregiver) to apply the device for continued use at home

The only time we cover a segmented, calibrated gradient pneumatic compression device (HCPCS code E0652) is when the patient has unique characteristics that prevent them from getting satisfactory pneumatic compression treatment using a non-segmented device with a segmented appliance or using a segmented compression device without manual control of pressure in each chamber.

Indications & Limitations of Coverage

We cover pneumatic devices that treat lymphedema or chronic venous insufficiency (CVI) with venous stasis ulcers.

Lymphedema

Lymphedema is the swelling of subcutaneous tissues due to excessive lymph fluid. The excess lymph fluid happens when the lymphatic system’s normal clearing function is impaired or there’s an excessive production of lymph, or both. Lymphedema is divided into 2 broad classes according to etiology:

• Primary lymphedema is a relatively uncommon, chronic condition that can be due to causes like Milroy’s disease or congenital anomalies
• Secondary lymphedema, which is much more common, happens when formerly functioning lymphatic channels are destroyed or damaged through surgical removal of lymph nodes or post-radiation fibrosis, among other causes

We cover pneumatic compression devices for treating lymphedema in the home if the patient has undergone a 4-week trial of conservative therapy and the treating physician determines that there has been no significant improvement or that significant symptoms remain after the trial. The trial of conservative therapy must include an appropriate compression bandage system or compression garment, exercise, and elevation of the limb. The garment may be prefabricated or custom-fabricated but must provide adequate graduated compression.

CVI with Venous Stasis Ulcers

CVI of the lower extremities is a condition caused by abnormalities of the venous wall and valves, leading to obstruction or reflux of blood flow in the veins. Signs of CVI include hyperpigmentation, stasis dermatitis, chronic edema, and venous ulcers.

We cover pneumatic compression devices in the home for treating CVI of the lower extremities only if the patient has 1 or more venous stasis ulcers that have failed to heal after a 6-month trial of conservative therapy directed by the treating physician. The trial of conservative therapy must include a compression bandage system or compression garment, appropriate dressings for the wound, exercise, and elevation of the limb.

Documentation Requirements

To justify payment, you must meet specific requirements when ordering DMEPOS.

We require a standard written order (SWO), and the medical records should show that the patient’s condition meets the applicable coverage criteria for pneumatic compression devices for treating lymphedema or CVI with venous statis ulcers.

Example of Improper Payments Due to Insufficient Documentation for Pneumatic Compression Devices

A supplier bills the claim for HCPCS code E0650 (Pneumatic compressor, non-segmental home model) and submits the following documentation per the review contractor’s request:

• SWO with correct HCPCS coding
• Treating practitioner’s medical record that doesn’t have complete documentation of the patient’s clinical response to the initial treatment with the device
• Proof of delivery

What Documentation Was Missing?

The patient’s medical documentation doesn’t meet the requirements of medical necessity for pneumatic compression devices.

What Happens Next?

The review contractor completes the claim as an insufficient documentation error, and the Medicare Administrative Contractor (MAC) recoups payment.

Recommendation

To prevent claim denials and improper payments, the certifying physician must collect and submit proper documentation of the clinical response to the initial treatment with the device into the treating practitioner’s medical record for the DME MAC. This information includes:

• Change in patient’s pre-treatment measurements
• Patient’s ability to tolerate the treatment session and parameters
• Patient’s (or caregiver’s) ability to apply the device for continued use in the home