| HCPCS Code | Description |
| E0676 | Intermittent limb compression device (includes all accessories), not otherwise specified |
General Coverage Criteria: Pneumatic compression devices are covered only when prescribed by a physician and when they are used with appropriate physician oversight and documentation, i.e., physician evaluation of the patient’s condition to determine medical necessity of the device, assuring suitable instruction in the operation of the machine, a written treatment plan defining the pressure to be used and the frequency and duration of use, and ongoing monitoring of use and response to treatment. The determination by the physician of the medical necessity of a pneumatic compression device must include documentation of the following:
- The patient’s diagnosis and prognosis;
- Symptoms and objective findings, including measurements, which establish the severity of the condition;
- The reason the device is required, including the treatments that have been tried and failed; and
- The clinical response to an initial treatment with the device
These criteria are derived from national and local Medicare policies, and coverage considerations are reflected in the CMN Certificate of Medical Necessity Form CMS-846.
Medicare
Medicare reimbursement is currently not available; however, ABF/ROMCare is actively seeking coverage from CMS. Although Medicare (CMS) does not cover ActiveCare at this time, if a patient has secondary insurance, Medicare may be billed for the purpose of obtaining denial coverage, which may be a prerequisite for the secondary payer.
Medicaid
Medicaid coverage and reimbursement varies from state to state. ABF/ROMCare contacts each state program for specific coverage, coding, and reimbursement policies, as well as documentation and other payment criteria.
Private Payer (Insurance Carriers)
Private payers may develop specific coverage policies outlining the criteria that must be met in order for a procedure or service to be covered. ABF/ROMCare contacts each payer with regard to specific reimbursement policies, coverage, documentation, payment and criteria.
Patient
ABF/ROMCare contacts each patient before being admitted to the hospital if time allows. If it is determined at that time that a portion of the bill will fall back to the patient, personnel from our office will take the opportunity to contact the patient and discuss any cost that the patient may incur, such as co-pays, partial payment or denial by their private insurance. If full payment cannot be made, a payment plan will be established.