Complex Lymphedema Therapy (Complete Decongestive Therapy) - (CPG157)

Cigna covers complex lymphedema therapy (complete decongestive therapy; HCPCS 97140/S8950) as medically necessary for intractable primary or secondary lymphedema but considers vasopneumatic/intermittent pneumatic compression (CPT 97016/IPC) and low‑level laser therapy not medically necessary/experimental and generally does not cover programs beyond four weeks. Coverage requires documented failure of conservative measures (home exercises, elevation, compression garments), objective limb function impairment, prescription/supervision by an appropriate provider, typical delivery of 2–5 sessions/week for ~2 weeks with transition to home self‑management, and exclusion of absolute contraindications (acute infection, DVT, active local malignancy), with supporting documentation of diagnosis, prior treatments, and treatment frequency/duration.

"Complex lymphedema therapy (complete decongestive therapy) is considered medically necessary for the treatment of intractable lymphedema when ALL of the following are met:"