Information for Clinicians – Medicare

Medicare will pay for the Flexitouch device (HCPCS E0652) when specific criteria outlined in the Medicare Coverage Policy are met. Our team of experienced Medicare specialists works closely with clinicians to help gather the necessary medical documentation required by Medicare. If at any time you have questions regarding Medicare criteria, please contact our office at 612–355–5100, or 866–435–3948 and ask to speak with a Medicare Specialist.

Getting started

To initiate a Medicare order, send us a copy of the patient’s medical record face sheet. After we have verified the patient’s primary insurance is Medicare, a Medicare Specialist will work together with the treating clinicians to gather required forms and records, and to determine if the patient’s case will meet Medicare’s requirements.

Medicare Criteria
  • Diagnosis of lymphedema with etiology and time of onset.
  • Significant lymphedema symptoms remain after a minimum of 4 weeks conservative therapies including compression, exercise and elevation.
  • Objective measurements and symptoms must be documented for pre and post conservative therapy.
  • Prior to Flexitouch prescription, a less costly basic pump must be used to determine if it meets the patient medical need, with documentation to show the basic pump’s level of effectiveness in treating the swelling, fibrosis, pain and ability to tolerate.
  • Treatment session with the Flexitouch System documenting the clinical response including measurements, ability to tolerate and ability to don/doff the Flexitouch garments.
  • Physician oversight of all phases of treatment demonstrated by physician notes and signatures on plans of care.
NOTE:  ALL CRITERIA MUST BE CLEARLY ADDRESSED IN THE MEDICAL RECORD
Resources
Medicare Criteria Documentation Guide

If Medicare criteria are not met, the patient may have interest in learning about other possible payment options, including coverage through a secondary payer or self-payment programs. The Medicare Specialist can review potential options and connect the patient with appropriate internal resources.

Medicare Frequently Asked Question’s