Pneumatic Compression Devices – Commercial and Individual Exchange Medical Policyopen_in_new

UnitedHealthcare covers pneumatic compression devices for lymphedema, for chronic venous insufficiency with edema and non‑healing lower‑extremity ulcers, and intermittent limb compression for DVT prevention only when the member meets InterQual® medical necessity criteria and required documentation supports the indication, with coverage ultimately subject to the member’s benefit plan. Advanced pneumatic devices for head/face/neck lymphedema and high‑pressure/rapid‑cycle devices for peripheral arterial disease are considered unproven and not medically necessary, and IPC/PCD use is contraindicated or limited in conditions such as PAD, peripheral neuropathy, severe edema, certain skin lesions/graft areas, and other trial‑listed exclusions.

"Pneumatic compression devices are considered proven and medically necessary in certain circumstances for the treatment of lymphedema when medical necessity clinical coverage criteria are met (see I..."