Compression Pumps for Treatment of Lymphedema and Venous Ulcers

This policy covers pneumatic/compression pumps for treatment of lymphedema (including limb, trunk/chest, and head/neck involvement) and for venous ulcers due to chronic venous insufficiency. Coverage requires prior failed conservative therapy (typically ≥4 weeks for lymphedema/nonprogrammable pumps and ≥6 months for venous ulcers), physician oversight with a documented treatment plan and objective measures; programmable/calibrated pumps are allowed only when nonprogrammable devices are inadequate (e.g., significant scarring), and pumps are excluded for indications such as diabetic neuropathic ulcers, arterial insufficiency/PAD, and other unproven uses and remain subject to the member’s benefit plan limits.

"Use of compression pumps for treatment of lymphedema."

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