3.0 POLICY
3.1 Lymphovenous
anastomosis by open surgical correction is a covered benefit.
3.2 Lymphedema pumps, both segmental
and non-segmental, are authorized durable medical equipment for
both institutional and home use.
4.0 POLICY CONSIDERATIONS
A physician’s prescription
is required for all claims for the segmental type pumps with or
without a calibrated pressure gradient.