Skip to main content

Medical Policy Update: Pneumatic Compression Pumps for Treatment of Lymphedema and Venous Ulcers

Effective October 29, 2019, Horizon BCBSNJ will change the way we consider certain professional claims based on updates to our medical policy, Pneumatic Compression Pumps for Treatment of Lymphedema and Venous Ulcers.

Access our Medical Policy Manual to review this medical policy content.¹


Claims submitted for services provided on and after October 29, 2019 to patients enrolled in Horizon BCBSNJ Medicare Advantage (MA) plans will be processed as follows.

  • Based on the submitted diagnosis code(s), information may be requested to help us determine the medical appropriateness of the services represented by CPT® codes E0650, E0651, E0656, E0657, E0655, E0660, E0665, E0666, E0667, E0668, E0669, E0670, E0671, E0672 or E0673. Following our review of medical record information, these services may be denied as not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member, based on a national coverage determination or local coverage determination.
  • Based on the submitted diagnosis code(s), the services represented by CPT codes E0650, E0651, E0656, E0657, E0655, E0660, E0665, E0666, E0667, E0668, E0669, E0670, E0671, E0672 or E0673 may be denied as not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member, based on a national coverage determination or local coverage determination.

Unless Horizon BCBSNJ gives written notice that all or part of the above changes have been canceled or postponed, the changes will be applied to claims for dates of service on and after October 29, 2019.

¹ The content of Horizon BCBSNJ medical policies that apply to Horizon BCBSNJ MA plans may include reference to pertinent National Coverage Determinations (NCDs) and/or Local Coverage Determinations (LCDs). We follow Centers for Medicare & Medicaid Services (CMS) guidelines, NCDs and/or LCDs in our processing of claims for services provided to our MA members. For those services where no LCD or NCD exists, claims for MA members will be processed based on our policy guidelines.

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

Published on: September 25, 2019, 09:19 AM ET
Last updated on: September 24, 2019, 09:21 AM ET