9/14/2023 0 Comments Sequential leg compression machine![]() You can use the Contents side panel to help navigate the various sections. The document is broken into multiple sections. This page displays your requested National Coverage Determination (NCD). ![]() Segmental lymphedema pumps, previously noncovered, are now covered as DME if necessary criteria are met. (TN 77)Ġ9/1986 - Added section to place lymphedema pumps and accompanying information together. (TN 81)Ġ6/1995 - Clarified that nonsegmented and segmented pump without manual control of pressure in each chamber is considered the least costly alternative that meets the clinical needs of the individual for this type of DME, unless there is documentation that warrants payment of the more costly manual control pump. ![]() ( TN 148) (CR 1944)ġ0/1995 - Changed effective date for TN 77 from NA to. ( TN 151) (CR 1944)ġ2/2001 - Clarified policy by dividing it into 2 separate parts based on indications and establishes different coverage criteria for the 2 different indications. The only time that a segmented, calibrated gradient pneumatic compression device (HCPCs code E0652) would be covered is when the individual has unique characteristics that prevent them from receiving satisfactory pneumatic compression treatment using a nonsegmented device in conjunction with a segmented appliance or a segmented compression device without manual control of pressure in each chamber.Ġ1/2002 - Clarified language previously found in TN 148 so that it is clear when segmented, calibrated gradient pneumatic compression devices will be covered. The clinical response includes the change in pre-treatment measurements, ability to tolerate the treatment session and parameters, and ability of the patient (or caregiver) to apply the device for continued use in the home.
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