Prescribing Home Pneumatic Compression: Coverage Criteria, 4-Week Trial, and Documentation
Navigating the process of prescribing a home pneumatic compression device (PCD) for lymphedema can be complex, but it doesn’t have to be. With clear Medicare guidance and the right documentation protocols, providers can confidently support patients in accessing effective at-home therapy.
At NextGen Medical Supplies, we partner with clinicians to simplify referrals, ensure compliance, and help patients receive timely, medically appropriate compression therapy. Here’s what providers need to know.
Medicare Coverage Overview (NCD 280.6)
Under National Coverage Determination 280.6, Medicare covers pneumatic compression devices prescribed for:
- Primary or secondary lymphedema, and
- Chronic venous insufficiency (CVI) with venous stasis ulcers
Devices are covered for home use when prescribed by a physician. Coverage applies to the following HCPCS codes:
- E0650 – Non-segmental home model (single-chamber)
- E0651 – Segmental home model with calibrated gradient pressure
- E0652 – Segmental device including trunk/chest/abdominal treatment
Conservative Therapy Trial Requirements
Before a PCD can be prescribed, patients must complete a minimum 4-week trial of conservative therapy (unless contraindicated). This trial should include:
- Compression garments or bandaging (prefabricated or custom)
- Exercise designed to stimulate lymph flow
- Elevation of the affected limb(s)
The goal is to show that swelling and symptoms persist despite these conservative measures. If little or no improvement is documented after the trial, the patient may qualify for a home pneumatic compression device.
Essential Documentation for Coverage
Accurate, detailed documentation is key to Medicare approval. The patient record should include:
Diagnosis and Clinical Findings
Common ICD-10 codes include:
- I97.2 – Postmastectomy lymphedema
- I89.0 – Lymphedema, not elsewhere classified
- Q82.0 – Hereditary lymphedema
Clinical documentation should note chronic and severe findings such as:
- Hyperkeratosis with hyperpigmentation
- Papillomatosis
- Skin breakdown with lymphorrhea
- Elephantiasis deformity
Conservative Therapy Documentation
- Dates and types of compression used
- Exercise and elevation routines
- Measurements before and after the trial
- Provider notes on symptom persistence or progression
Physician Oversight
- Face-to-face visit within six months of the order
- Signed plan of care or clinical notes supporting the need for home therapy
- Standard Written Order (SWO) that includes:
- Patient name
- Device type and prescribed pressure settings
- Physician NPI
Special Considerations for E0652 Devices
For patients with trunk, chest, or abdominal involvement, additional documentation must demonstrate:
- Initial treatment with an E0651 device
- Pre- and post-treatment measurements
- Frequency and duration of therapy sessions
- Clear medical justification for upgrade to E0652 coverage
Partnering with NextGen Medical Supplies
NextGen Medical Supplies is a trusted partner for providers prescribing lymphedema compression therapy. Our team helps ensure your documentation meets Medicare standards and your patients receive care without delays. We assist by:
- Reviewing documentation for NCD/LCD compliance
- Coordinating patient education and training
- Supporting insurance authorization and submission
- Ensuring timely device delivery and follow-up care
Let’s Simplify the Process Together
Whether you’re a physician, therapist, or referral coordinator, NextGen is here to help you navigate the complexities of Medicare pneumatic compression coverage. We make it simple for you, and seamless for your patients.
Ready to refer a patient? Contact NextGen Medical Supplies to connect with our clinical support team or submit documentation through our online referral portal.
