When Does Medicare Cover Lymphedema Pumps?
Living with lymphedema can be challenging. Swelling, discomfort, and reduced mobility can interfere with daily life. This is especially true when conservative treatments aren’t enough to manage your symptoms.
The good news? Medicare now provides comprehensive coverage for lymphedema treatment, including pneumatic compression devices (often known as lymphedema pumps). If you or a loved one is considering a lymphedema pump, here’s what you need to know about Medicare coverage, eligibility requirements, and how to get the device you need.
Understanding Lymphedema and Why Pumps Are Needed
Lymphedema is a chronic condition that occurs when your lymphatic system becomes damaged or blocked. This leads to fluid buildup that most commonly occurs in the arms, legs, or both and can cause:
- Swelling
- Pain or heaviness
- Increased risk of infection
- Reduced mobility
- Difficulty with daily activities
Conservative therapy such as compression garments, elevation, and manual lymphatic drainage (MLD) is typically the first line of treatment. However, some patients don’t respond to conservative methods and need more support to manage their symptoms effectively. That’s where pneumatic compression devices (PCDs) can help.
These devices use timed pressure cycles to move lymphatic fluid out of affected areas, helping reduce swelling and improve comfort.
Does Medicare Cover Lymphedema Pumps?
Yes. As of January 1, 2024, Medicare has expanded coverage for lymphedema treatment under the Lymphedema Treatment Act. This includes:
- Standard pneumatic compression devices (E0650, E0651)
- Advanced programmable compression devices (E0652) for more complex cases
- Compression garments, bandaging supplies, and accessories
This expansion is one of the biggest improvements in lymphedema care in Medicare history, offering better access to essential treatments and improving long-term health outcomes.
When Will Medicare Approve a Lymphedema Pump?
Medicare will typically approve a lymphedema pump when ALL the following conditions are met:
- A confirmed diagnosis of lymphedema: Your physician must document your diagnosis—whether primary (genetic) or secondary (caused by cancer treatment, surgery, trauma, or infection).
- Symptoms must be chronic and severe: Medicare requires documentation of ongoing swelling, pain, or functional impairment.
- Conservative therapy must be attempted first: Before approving a pump, Medicare expects patients to try standard treatments, such as:
- Compression garments
- Elevation
- Exercise
- Manual lymphatic drainage
Note: It’s important to know that you don’t have to “fail” these treatments, but your provider must show they are not fully controlling your symptoms.
- A physician must provide a detailed prescription: A Medicare-approved prescription must include:
- Your diagnosis
- A statement of medical necessity
- The type of compression device recommended
- Confirmation that conservative treatment was attempted
- Your provider’s signature and date
- The pump must be used at home: Medicare covers DME (Durable Medical Equipment) intended for use in the home — not in clinics or therapy offices.
Types of Lymphedema Pumps Medicare Covers
Medicare classifies pumps into two main categories:
Standard Compression Pumps (E0650–E0651)
These devices provide uniform, sequential pressure.
Covered for:
- Moderate to severe lymphedema
- Patients who need additional support beyond conservative care
Advanced Programmable Pumps (E0652)
These devices offer more precise pressure settings for each limb segment.
Covered for:
- Severe, treatment-resistant lymphedema
- Patients with fibrosis, truncal involvement, or highly complex needs
Your doctor determines which category best fits your condition.
What Will I Pay With Medicare?
If you have Medicare Part B, coverage typically includes:
- 80% of approved costs after your deductible
- 20% coinsurance, unless you have a Medigap plan that covers it
- Coverage through a Medicare‑approved DME supplier (like NextGen Medical Supplies)
Most patients pay little to nothing out of pocket, depending on supplemental insurance.
How to Get a Lymphedema Pump Through Medicare
NextGen Medical Supplies makes the process simple from start to finish. Here’s how it works:
- Get a medical evaluation – Speak with your doctor about your symptoms and treatment history.
- Obtain documentation – Your provider must supply:
- Detailed chart notes
- Your lymphedema diagnosis
- A statement of medical necessity
- Proof of conservative treatment
- A prescription for the device
- Choose a Medicare‑approved supplier – NextGen Medical Supplies works directly with Medicare and your provider to verify coverage.
- Receive your device at home – Once approved, your pump is delivered, and our team helps you get started with setup and use.
Why Early Treatment Matters
Untreated or undertreated lymphedema can lead to:
- Fatigue
- Skin changes and thickening
- Infections like cellulitis
- Decreased mobility
- Permanent tissue damage
Using a lymphedema pump consistently helps:
- Reduce swelling
- Improve mobility
- Support lymphatic function
- Prevent complications
- Improve overall quality of life
Early intervention is key to long-term symptom management.
Get Help Navigating Medicare Coverage
Navigating Medicare coverage can feel overwhelming, but you don’t have to figure it out alone. At NextGen Medical Supplies, our team specializes in helping patients access the equipment they need with minimal stress.
We’ll work with your physician, submit all required documentation, and guide you through every step of the process.
Have questions about coverage or eligibility for a lymphedema pump? We’re here to help; contact us today to speak with a member of our team.
