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Pneumatic compression pumps and limb compression devices
September 15, 2021

This article is for durable medical equipment suppliers

Blue Cross covers pneumatic compression pumps for treatment of lymphedema and venous ulcers (Medical policy 354) and postsurgical home use of limb compression devices for venous thromboembolism prophylaxis (Medical policy 541).

As a reminder, the medical policies describe conditions that must be met for these devices to be covered for our commercial members:

  • Medical policy 354: Pneumatic compression pumps are covered for the treatment of lymphedema.
  • Medical policy 541: Limb compression devices are covered in the home setting for the prevention of venous thromboembolism (VTE) after a major orthopedic or non-orthopedic surgery for patients who are at moderate or high risk of VTE.

Payment policy application

  • Enforcement of this medical policy occurs through system edits and post-payment reviews.
  • We continually expand our ability to process claims in accordance with this policy pre-payment, which will reduce the number of claims we review post-payment.


The included HCPCS codes and diagnoses are listed on their respective medical policies, which will be updated on our website on October 15. To download these medical policies, log in and click Find a Medical Policy on the right side of your home page. Or, go to Office Resources>Policies & Guidelines>Medical Policies.