Compression Pumps

By August 15, 2026: Billing and clinical teams must implement prior authorization protocols for compression pump claims. (1) Update billing system to require documentation of medical appropriateness criteria before claim submission: for lymphedema cases, document failure of conservative measures (elevation, compression garments); for DVT prophylaxis, document specific postoperative indication and contraindication to anticoagulation. (2) Deny all claims for head/neck compression pumps, venous ulcer treatment, and non-FDA-approved devices—mark as investigational/non-covered. (3) Create encounter form checkboxes requiring providers to specify: treatment indication (lymphedema vs. DVT prophylaxis vs. other), device type (pneumatic nonprogrammable, pneumatic programmable, or non-pneumatic), and documented conservative therapy failure or clinical characteristics justifying escalation. (4) Train front desk and billing staff to flag claims lacking required documentation and route to clinical review before submission. Claims submitted without proper medical appropriateness documentation will be denied and result in patient balance responsibility.