Lymphedema

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.

October is Breast Cancer Awareness Month, a time to honor survivors and raise awareness about the long-term effects of treatment. One common condition that many survivors face is lymphedema, a chronic buildup of fluid that causes swelling, discomfort, and reduced mobility, most often in the arms or legs.

For many breast cancer survivors, especially those who have had lymph nodes removed or received radiation therapy, lymphedema becomes an ongoing challenge. Fortunately, lymphedema pumps, also known as home compression pumps, offer an effective way to manage symptoms and improve daily comfort.

What Is Lymphedema and Why Does It Happen?

Lymphedema occurs when the lymphatic system is damaged or blocked, preventing lymph fluid from draining properly. This causes fluid to collect in tissues, leading to swelling, tightness, and sometimes pain. It’s especially common after breast cancer treatment involving lymph node removal or radiation therapy.

Common symptoms include:

• Swelling in the arm, leg, chest, or trunk
• A feeling of heaviness or tightness
• Reduced range of motion
• Skin changes or a higher risk of infection

How Compression Therapy Helps

Compression therapy is one of the most effective ways to manage lymphedema. It works by applying gentle, controlled pressure to the affected area, helping move trapped lymph fluid back into circulation.

Lymphedema pumps, or intermittent pneumatic compression (IPC) devices, use inflatable sleeves with multiple chambers that inflate and deflate in a sequence. This action mimics the body’s natural lymphatic flow, helping reduce swelling, improve comfort, and restore mobility.

Benefits of home compression therapy:

• Noticeable swelling reduction and limb-size control
• Better mobility and range of motion
• Increased comfort and reduced heaviness
• Convenient home use with customizable settings

What to Expect When Using a Lymphedema Pump at Home

Using a lymphedema pump at home is simple and can be highly effective when done correctly. Always follow your healthcare provider’s guidance and the device instructions.

Best practices include:

• Consult your healthcare provider or certified lymphedema therapist before starting pump therapy.
• Choose the correct sleeve size to ensure even, effective compression.
• Start with shorter sessions (15–30 minutes) and increase gradually as advised.
• Use the pump consistently, ideally once daily, to maintain results.
• Combine pump use with manual lymphatic drainage, compression garments, and gentle exercise for best outcomes.

Tips for Safe and Effective Use of Compression Pumps

Here are some additional tips to keep you safe while using your home compression pump effectively:

• Avoid use during active infections or on open wounds.
• Keep the skin clean and moisturized to prevent irritation.
• Elevate the limb after each session to enhance fluid return.
• Monitor for any changes in swelling, skin condition, or pain, and contact your provider if symptoms worsen.

Why This Matters During Breast Cancer Awareness Month

Up to 40% of breast cancer survivors develop some level of lymphedema, often in the arm or chest area. Early management and consistent home care can make a significant difference in long-term comfort and mobility.

By understanding how compression therapy works and using tools like lymphedema pumps, patients and caregivers can take proactive steps toward recovery, independence, and improved quality of life.

Explore Lymphedema Pump Options with NextGen Medical Supplies

At NextGen Medical Supplies, we provide a range of home compression pumps designed to help you manage lymphedema safely and comfortably. Our compassionate team can help you find the right solution for your needs, and guide you through insurance coverage, setup, and follow-up care!

Take the first step toward swelling relief and greater mobility. Contact NextGen Medical Supplies to learn more about our lymphedema compression options.