Pneumatic Compression Pumps - Medicare Advantage

This policy covers pneumatic compression pumps — including advanced multicompartmental programmable and ambulatory battery‑powered devices (e.g., Flexitouch, Lympha Press, AIROS models) — for treatment of chronic venous insufficiency with venous stasis ulcers, lymphedema, and related chronic peripheral edema, consistent with CMS NCD 280.6 and related Humana lymphedema guidance. Coverage is limited to uses deemed reasonable and necessary under Medicare and the referenced NCD/related policies; prophylactic DVT pumps (HCPCS E0676) and high‑pressure rapid‑inflation devices for arterial insufficiency/PAD (HCPCS E0675) are excluded or not considered medically reasonable and necessary, and specific criteria must be met for payment.

"Prevention of venous thromboembolism"

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