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Q. Have you found that insurance will not pay for a compression pump without treating a patient's venous insufficiency with ablation first?

Back in 2001 CMS completed a study (CAG00016N) based on the scant pre-2000 literature on the use of sequential pneumatic pumps to treat lymphedema. Most of the literature at that time dealt with the use of pumps in the treatment of venous problems and manufacturers were anxious to extend the market to lymphedema. That study resulted in a decision that I heartily support — that venous disease and lymphedema are different, and pump use is unique to the condition you are treating. I suggest that you read the article on sequential pneumatic devices on my LymphActivist's Site at

The situation becomes far more complex when the primary venous insufficiency causes a lymphatic system overload leading to lymphedema secondary to venous insufficiency. Now, which condition do you treat, in what order and with what kind of pump? Medicare still separates the treatment and does not deal with combined conditions.

Insurance companies must adhere to Medicare guidelines, in this case National Coverage Determination for Pneumatic Compression Devices NCD #280.6, written in 2002 and never updated to reflect advances in our state of knowledge and advances in pump technologies. Pumps are indicated for diagnosed lymphedema if four weeks of "conservative" treatment has failed, and for venous insufficiency if there are venous ulcers which have not healed after six months of treatment. Coverage for the combined lymphovenous (phlebolymphatic?) edema is not addressed, so the insurance companies are free to interpret according to their corporate culture.

I would suggest that if a pump for lymphedema treatment is denied because of an absence of a venous ulcer or a diagnosis of venous insufficiency, medical review should be requested on the basis that pumps may also be indicated for the treatment of lymphedema according to Medicare, and that the coverage criteria as well as the type of pump are different from those used in treatment of venous insufficiency.