Pneumatic and Non-Pneumatic Compression Devices - DME.SW.109.A

Covers pneumatic (E0650–E0652, E0675, E0676) and non‑pneumatic compression devices (E0680–E0682) and related accessories for chronic lymphedema, chronic venous insufficiency, DVT prophylaxis in high‑risk immobile patients, and select PAD/CLI patients without revascularization options, but excludes concurrent use of pneumatic and non‑pneumatic devices, calibrated‑gradient pumps (E0652) for swelling confined to the limbs, accessories without an approved base device, and use when contraindications exist (e.g., active DVT/PE, pulmonary edema, infection/cancer in the treatment area, NYHA III/IV heart failure, unhealed/unalignable limb deformity). Key requirements include detailed documentation and trials (≥4 weeks of conservative therapy and daily measurements for lymphedema with specified skin/tissue findings; a 6‑month comprehensive care course for CVI), demonstrated ability to use/manage the device with training, and for E0652 a documented 4‑week trial of E0650/E0651 showing no improvement plus correction/assessment of contributing medical/nutritional factors; only one compression device is covered at a time.