Pneumatic Compression Devices — NCD 225 | CMS Coverage Update

TL;DR: The Centers for Medicare & Medicaid Services modified NCD 225 governing Medicare coverage of pneumatic compression devices, effective March 7, 2026. Here's what billing teams need to know before claims hit the queue.

CMS updated its National Coverage Determination 225—the policy governing pneumatic compression devices (PCDs) for home use—with a modification effective 2026-03-07. This policy covers inflatable garments and electric pumps used to treat lymphedema and chronic venous insufficiency (CVI) with venous stasis ulcers. The real policy document references HCPCS code E0652 specifically for segmented, calibrated gradient pneumatic compression devices, though the full code list is not published with this version. If your DME billing team handles any PCD claims billed to Medicare, this policy governs your reimbursement eligibility and medical necessity documentation requirements.

Quick-Reference Table

CMS Pneumatic Compression Device Coverage Criteria and Medical Necessity Requirements 2026

NCD 225 is the National Coverage Determination governing Medicare coverage of pneumatic compression devices under the Durable Medical Equipment benefit category. The coverage policy is narrow and conditional—Medicare does not cover PCDs as a first-line intervention. Two clinical indications qualify, and each has its own documentation ladder your billing team needs to understand cold.

Lymphedema: Medicare covers PCDs in the home setting for lymphedema patients only after a four-week trial of conservative therapy. That trial must include all three elements: an appropriate compression bandage system or compression garment, exercise, and limb elevation. The treating physician must determine that the trial produced no significant improvement, or that significant symptoms remain despite completion. Missing any leg of that three-part trial in your documentation is a direct path to claim denial.

Chronic Venous Insufficiency with Venous Stasis Ulcers: For CVI patients, the bar is higher. The patient must have one or more venous stasis ulcers that failed to heal after a six-month trial of conservative therapy directed by the treating physician. That trial must include a compression bandage system or garment, appropriate wound dressings, exercise, and limb elevation. Six months is a long time—make sure your documentation captures the start date of conservative therapy, not just the date the physician ordered the device.

Both indications require physician prescription and ongoing physician oversight. The CMS coverage policy is explicit on what "oversight" means: evaluation to determine medical necessity, instruction in device operation, a treatment plan specifying pressure settings and frequency/duration of use, and ongoing monitoring of the patient's response. Physicians who simply sign an order without this documented oversight chain put your DME claim at serious risk.

The medical necessity determination itself must include four specific elements per NCD 225:

That fourth point trips up a lot of DME suppliers. The initial treatment response has to be documented before Medicare considers ongoing home use medically necessary. If you're submitting claims without that initial response documentation, you're billing blind.

There is no prior authorization requirement specified in this NCD, but that doesn't mean your MAC won't have local coverage determination (LCD) requirements layered on top. Check your jurisdiction's LCD for pneumatic compression devices before March 7, 2026.

CMS Pneumatic Compression Device Exclusions and Non-Covered Indications

The policy makes one specific coverage limitation explicit: HCPCS code E0652—the segmented, calibrated gradient pneumatic compression device—is only covered under specific circumstances. The policy document as provided is truncated at the exact point where CMS describes those circumstances, which is a documentation risk your billing team should flag now.

The practical implication: don't assume E0652 coverage defaults to the same rules as simpler PCD devices. If your team bills E0652, verify against the full NCD 225 text at CMS.gov and confirm your medical necessity documentation meets whatever the specific E0652 threshold is. If you're not certain how E0652's criteria apply to your patient mix, loop in your compliance officer before the March 7, 2026 effective date.

PCDs are also only covered in the home setting—not in facility settings where the DME benefit doesn't apply. A claim for inpatient or outpatient facility-based PCD use under this NCD will not be payable under these coverage rules.

Coverage Indications at a Glance

CMS Pneumatic Compression Device Billing Guidelines and Action Items 2026

CPT, HCPCS, and ICD-10 Codes for Pneumatic Compression Devices Under NCD 225

The policy data for NCD 225 does not publish a complete code list in the version captured here. The policy summary truncates before listing all applicable codes. One HCPCS code is referenced explicitly in the policy narrative:

HCPCS Codes Referenced in Policy Narrative

A Note on Missing Codes

The absence of a full code list in the policy data is itself worth flagging. CMS NCDs typically reference a range of E-codes for pneumatic compression devices (various configurations of sleeves, pumps, and multi-chamber systems), but those codes are not confirmed in this version of NCD 225's published data.

Do not build your charge capture or LCD crosswalk assumptions on codes not listed here. Pull the complete NCD 225 from the CMS website directly, cross-reference with your MAC's LCD, and confirm the full applicable code set with your DME billing specialist before March 7, 2026. If you're unclear on how this maps to your specific device mix, your compliance officer or a DME-specialized billing consultant is the right resource—not an assumption.