For lymphedema therapists and prescribing providers
Most pump denials come down to missing documentation, not a lack of medical need. Knowing which device code fits and what the chart notes must show gets patients their pump faster.
The device codes
E0650 — Device: Non-segmental pump; Typically used when: Rarely used for lymphedema today
E0651 — Device: Segmental pump without calibrated gradient pressure; Typically used when: Standard choice for extremity lymphedema
E0652 — Device: Segmental pump with calibrated gradient pressure; Typically used when: The patient has a specific need that E0651 can't meet
E0652 requires extra justification. Most insurance plans want documentation of why a simpler pump wouldn't work, such as significant scar tissue or fibrosis that needs pressure in specific segments, or swelling that extends into the trunk, chest or genital area.
What most plans require
A qualifying diagnosis, usually lymphedema, with the ICD-10 code
A signed, dated prescription from the treating provider
A documented trial of conservative therapy, typically four weeks, that didn't adequately control the swelling
A face-to-face visit with the prescribing provider about the condition
Prior authorization with many plans
Requirements vary by plan, so we confirm them for each patient.
Documenting the conservative therapy trial
The chart notes should show that the patient tried these steps and that swelling persisted:
Compression: garments, wraps or bandaging, worn as prescribed
Elevation of the limb when possible
Exercise: a home exercise program
Skin care and, when applicable, manual lymphatic drainage
Strong notes include:
Start and end dates of the trial
Limb measurements (circumference or volume) before and after
What the patient did and how consistently
The result: why swelling isn't adequately controlled
Symptoms and functional impact, such as heaviness, pain, wounds, infections or trouble with daily activities
Common reasons for denial
No measurements, or only one set
Trial too short, or no dates
Notes unsigned or not from the prescribing provider
No explanation of why the trial failed
E0652 ordered without justification
How Midwest Compression can help
We review documentation before submitting, tell you exactly what's missing, and assemble the prior authorization package. Orders can be sent through Parachute Health. Email customersupport@midwestcompression.com or call 800-883-1549.
Need forms? Find every measurement form, sizing guide and order form on our Measurement & Sizing Forms page, and manufacturer charts on our Size Charts page.
This article is general guidance. Coverage criteria vary by insurance plan and change over time.
