![]() ![]() Patients with a prior history of lymphedema or who are prone to developing deep vein thrombosis should talk to their surgeons before surgery.Ī whole leg compressions machine like the FitKing Air Compression Recovery System or the Therabody RecoveryAir PRO system may help reduce and manage lymphedema prior to surgery and after surgery.īilling Codes for a Whole Leg Compression MachineĮ0650 - PNEUMATIC COMPRESSOR, NON-SEGMENTAL HOME MODELĮ0651 - PNEUMATIC COMPRESSOR, SEGMENTAL HOME MODEL WITHOUT CALIBRATED GRADIENT PRESSUREĮ0652 - PNEUMATIC COMPRESSOR, SEGMENTAL HOME MODEL WITH CALIBRATED GRADIENT PRESSURE PCDs for the Treatment of Peripheral Artery DiseaseĮdema is a common post surgical impairment following total knee replacement surgery.PCDs for the Treatment of Lymphedema or Chronic Venous Insufficiency (CVI) With Ulcers. ![]() In order for a beneficiary’s equipment to be eligible for reimbursement, the reasonable and necessary (R&N) requirements set out in the related Local Coverage Determination must be met." Medicare Policy Article A52488 - Pneumatic Compression Devices was revised on and is currently the most up-to-date resource indicates that "Pneumatic Compression Devices (PCDs) are covered under the Durable Medical Equipment benefit (Social Security Act §1861(s)(6)). Medicare Coverage Guidelines for a Leg Compression Machine It is always a good idea to consult with your insurance provider and healthcare team before undergoing a procedure or starting a new treatment to determine if it will be covered by your insurance. However, the specific criteria used by insurance companies can vary, and some insurance policies may have different requirements or restrictions for coverage. In general, health insurance companies will cover devices or procedures that are deemed "reasonable and medically necessary," as long as they meet the criteria outlined above. They also consider factors such as the individual patient's specific medical history and the treatment plan recommended by their healthcare provider. Health insurance companies use these criteria to determine whether a device or procedure is covered by the insurance policy. Medical necessity: The device or procedure must be deemed medically necessary by the patient's healthcare provider and must be used to diagnose, treat, or prevent a medical condition.Ĭlinical efficacy: There must be evidence that the device or procedure is effective in treating the medical condition, based on accepted standards of medical practice and scientific research.Ĭost-effectiveness: The device or procedure must be a cost-effective option compared to alternative treatments, taking into account factors such as patient outcomes, the availability of other treatments, and the potential side effects. In other words, for a device or procedure to be considered "reasonable and medically necessary," it must meet certain criteria: This term refers to the requirement that a particular treatment, device, or procedure be both medically appropriate and necessary for the individual patient's medical needs and that it also represents a reasonable or cost-effective use of medical resources. ![]() " Reasonable and medically necessary" is a term that is commonly used by health insurance companies to determine whether a device or procedure will be covered by insurance. In this article, I will explain what this means and share resources from different popular health insurance policies to help you better understand if you will qualify from a leg compression machine after knee surgery.ĭefine: Reasonable and Medically NecessaryĮach insurance provider may have a slightly different definition of reasonable and medically necessary, but a good general explanation is: Yes, health insurance pays for the use of a pneumatic compression device after surgery when it is deemed reasonable and medically necessary by your surgeon or medical professional. Does Insurance Pay for a Leg Compression Machine After Knee Surgery ![]()
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