Medical Policy Update: End Diastolic Pneumatic Compression Boot as a Treatment of Peripheral Vascular Disease or Lymphedema

Effective October 15, 2018, Horizon Blue Cross Blue Shield of New Jersey will change the way we process claims for certain services provided to patients enrolled in Horizon Blue Cross Blue Shield of New Jersey Medicare Advantage (MA) plans. 

Our medical policy, End Diastolic Pneumatic Compression Boot as a Treatment of Peripheral Vascular Disease or Lymphedema, includes reference to National Coverage Determination (NCD) 280.6: Pneumatic Compression Devices and to Local Coverage Determination (LCD) L35094: Services That Are Not Reasonable and Necessary.

  • Horizon BCBSNJ will follow this NCD/LCD and Centers for Medicare & Medicaid Services (CMS) guidelines in our processing of claims for services provided to Horizon BCBSNJ MA members.
  • For services where no NCD or LCD exists, claims for services provided to MA members will be processed based on policy guidelines.

Access our Medical Policy Manual to review the End Diastolic Pneumatic Compression Boot as a Treatment of Peripheral Vascular Disease or Lymphedema medical policy.


Claims for services provided on and after October 15, 2018 to patients enrolled in Horizon BCBSNJ MA plans will be processed as noted below.

  • CPT® code 92971 may be denied, based on the submitted diagnosis code(s), as an experimental/investigative service.

Unless Horizon BCBSNJ gives written notice that all or part of the above changes have been cancelled or postponed, the changes will be applied to claims on and after October 15, 2018.

CPT® is a registered mark of the American Medical Association.

Published on: September 14, 2018, 11:20 AM ET
Last updated on: September 14, 2018, 12:23 PM ET