CG-DME-46 Pneumatic Compression Devices for Prevention of Deep Vein Thrombosis of the Extremities in the Home Setting

This policy addresses pneumatic compression devices (PCDs) used in the home setting to prevent deep vein thrombosis/venous thromboembolism (VTE) of the extremities (HCPCS/CPT A4600, E0650–E0672). Anthem deems home use of PCDs for VTE prevention not medically necessary and therefore not covered. This determination applies to all prophylactic indications in the home setting; no coverage exceptions are noted, and the policy does not address inpatient/perioperative use or other clinical indications (e.g., treatment of lymphedema).

"The use of pneumatic compression devices in the home setting for prevention of venous thromboembolism of the extremities is considerednot medically necessaryfor all indications."

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