Covered by Medicare for the treatment of lymphedema or for the treatment of chronic venous insufficiency (CVI) with venous stasis ulcers.

Lymphedema coverage: The patient must undergo a four-week trial of conservative therapy that, when concluded, the physician determines there has been no significant improvement. Conservative therapy includes:

• Use of an appropriate compression bandage system or compression garment (prefabricated or custom, must provide gradiated compression).
• Exercise
• Elevation of the limb

Chronic Venous Insufficiency (CVI) with venous stasis ulcers coverage: The patient must have one or more venous stasis ulcer that has failed to heal after six months of conservative therapy which has been directed by the treating physician. Conservative therapy includes:

• Use of an appropriate compression bandage system or compression
• Appropriate dressings for the wound
• Exercise
• Elevation of the limb

For a diagnosis of CVI with venous stasis ulcers, a signed and dated CMN plus documentation that has been signed and dated by the physician supporting medical necessity is required. This documentation must include:

• Location and size of venous stasis ulcer(s)
• Length of time ulcer has been present
• Conservative treatment method as listed above
• History of regular visits with the physician for the conservative treatment period (6 months)

If a segmental, calibrated gradient pressure pneumatic compression device is ordered, the physician must indicate the following:

• Treatment plan
• Each chamber pressure
• Frequency and duration of each treatment
• Results of previous trial on non-calibrated gradient compression device or non-segmented compressor with segmented appliance.
• Why additional features are needed
• Name, model number and manufacturer of the device