Lymphedema Pumps are covered for treatment of true lymphedema as a result of:

• Primary Lymphedema resulting from a congenital abnormality of lymphatic drainage or Milroy’s disease.  (This is a relatively uncommon, chronic condition), or

• Secondary lymphedema is much more common and results from the destruction of or damage to formerly functioning lymphatic channels such as:

  • radical surgical procedures with removal of regional groups of lymph nodes (for example, after radical mastectomy),

  • post-radiation fibrosis,

  • spread of malignant tumors to regional lymph nodes with lymphatic obstruction,

  • or other causes

• Before you can be prescribed a pump, your physician or healthcare provider must monitor you during a minimum, four-week trial period where other treatment options must be tried including limb elevation, exercise and compression garments or bandage systems. If, at the end of the trial, there is little or no improvement from these options, a lymphedema pump can be considered.

• The doctor or healthcare provider must then document an initial treatment with a pump and establish that the treatment can be tolerated.

Lymphedema pumps also are covered for the treatment of chronic venous insufficiency (CVI) with venous stasis ulcers in the lower extremities (e.g. legs and feet).

• Before you can be prescribed a pump for this condition, your physician or healthcare provider must monitor you during a minimum, six month trial period where other treatment options are tried such as limb elevation, exercise and compression garments or bandage systems. If at the end of the trial, one or more of the stasis ulcers are still present, a lymphedema pump can be considered.

• The doctor or healthcare provider must then document an initial treatment with a pump and establish that the treatment can be tolerated, that there is a caregiver available to assist with the treatment in the home, and then the doctor or healthcare provider must prescribe the pressures, frequency, and duration of prescribed use.

Depending on which product is ordered, your supplier may not be able to deliver this product to you without a written order or certificate of medical necessity from your doctor or healthcare provider, nor can they get the documentation at a later date because if they do, Medicare can never make payment for those products to you or your supplier.  So please be patient with your supplier while they collect the required documentation from your physician or healthcare provider.