Detailed measurements over time confirming the persistence of the lymphedema with a history evidencing a likely etiology and.Skin breakdown with persisting lymphorrhea, or.Marked hyperkeratosis with hyperplasia and hyperpigmentation.The member has persistence of chronic and severe lymphedema as identified by the documented presence of at least one of the following clinical findings:.The member has a diagnosis of lymphedema and.Pneumatic Compression Device Without Calibrated Gradient PressureĪetna considers home use of a non-segmented (unicompartmental) device or segmented (multicompartmental) pneumatic compression device without manual control of the pressure in each chamber medically necessary for members with chronic and severe lymphedema when all of the following requirements are met:.The member has shown a past record of compliance and the member or his/her caregiver is capable of following the instructions associated with CDP.Īetna considers lymphedema pumps (pneumatic compression devices) medically necessary durable medical equipment (DME) for home use according to the following criteria: One or more previous admissions to treat complications of intractable lymphedema (i.e., cellulitis, ulceration) and.Intractable lymphedema of the extremities, unrelieved by elevation or.Evidence of ulceration due to lymphedema or.The member has any of the following conditions: ![]() ![]() This Clinical Policy Bulletin addresses lymphedema.Īetna considers a course of complex decongestive physiotherapy (CDP), also called complete decongestive therapy, or manual lymphoid drainage, medically necessary when both of the following criteria are met: Please contact us to learn more about our products or for a list of local dealers near you.Number: 0069 Table Of Contents Policy Applicable CPT / HCPCS / ICD-10 Codes Background References Paradigm Medical is a wholesale/distributor that offers a wide variety of lymphedema supplies including pneumatic compression pumps, compression bras and lymphedema footwear. These products are typically used for cosmetic purposes in spas and are not recommended for use in the treatment of Lymphedema. Purchasing a pump online or out of the country is not recommended since careful fitting and selection is required and not doing so could put your health at risk.ĬAUTION: Many non-medical pumps are marketed for the treatment of edema. These are Class II Medical Device and are manufactured with the highest quality standards to ensure efficacy and safety. Zaleska et al: Lymphatic Researchand Biology Volume 00, Number 00, 2015. Intermittent Pneumatic Compression Enhances Formation of Edema Tissue Fluid Channels in Lymphedema : Compression of limb lymphedema tissues leads to formation of tissue channels as pathways for evacuation of edema fluid. * Decongestive Lymphatic Therapy for Patients with Breast Carcinoma-Associated Lymphedema: When IPC is used adjunctively with other, established elements of DLT, it provides an enhancement of the therapeutic response. Covered by most Canadian private insurance and some provincial health care plans.Adverse results are very rare if used correctly. ![]()
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