Medicare Order Process – Lymphedema

To initiate a Medicare order for a product to treat lymphedema, fax a copy of the patient’s medical record face sheet to Tactile Medical at 866.435.3949. After we have verified that Medicare is the patient’s primary insurance, a Medicare Specialist will work with you to determine the appropriate pneumatic compression device for your patient, based upon medical documentation and Medicare’s coverage criteria outlined below. We will provide guidance on any required forms and documentation.

The patient’s medical records must include the following documentation to meet criteria:

Entré System (HCPCS E0651)

  • A documented diagnosis of lymphedema
  • Objective findings that establish the severity of the condition
  • The patient has completed at least four weeks of conservative therapies including exercise, elevation and appropriate compression
  • The patient continues to exhibit significant symptoms despite compliance with conservative therapies
  • Physician oversight of all treatment provided, including the reason for ordering a pump

Flexitouch® System (HCPCS E0652)

  • Meets criteria for basic pump, plus:
  • Clear evidence that use of the basic noncalibrated pressure pump (HCPCS E0651) was ineffective in treating the patient’s condition
  • The patient’s unique characteristics that prevent satisfactory treatment with basic pump
  • Justification for why a more advanced level of pump (HCPCS E0652) is medically necessary to meet the patient’s needs

Download the Medicare Coverage Criteria for Lymphedema guide >