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Pneumatic Compression Devices

CMS requires prior authorization of these Pneumatic Compression Devices HCPCS codes for all states and territories for dates of service on and after April 13, 2026.

How to Send Your Request

When to Expect the Decision

We will send a detailed decision letter by the fifth business day not to exceed seven calendar days.

Expedited requests: If there is a valid need for an expedited review, we will make reasonable efforts to send a decision within two business days.

We will base the prior authorization decision on the National Coverage Determinations (NCD) ManualExternal PDF (CMS Pub. 100-03), Chapter 1, Section 280.6 and the Standard Documentation Requirements for All Claims Submitted to DME MACs (A55426)External Website.

Expedited Reviews

Only request an expedited review if a delay of the prior authorization decision could jeopardize the life or health of the beneficiary.

Deliver the PCD Within 60 Calendar Days

Prior authorization decisions for PCDs are valid for 60 calendar days after the provisional affirmation review decision. If the supplier does not deliver the items within 60 calendar days of the decision, the supplier will need to send another prior authorization request.

Reasons for Non-Affirmed Prior Authorization for Pneumatic Compression Devices

  • The medical record documentation does not support the beneficiary is being treated for lymphedema or chronic venous insufficiency with venous stasis ulcers.
  • The medical record documentation does not support there has been a four-week trial that includes a compression bandage system or compression garment with exercise and elevation of the limb.
  • The medical record documentation does not demonstrate the beneficiary's clinical response to the initial treatment by including pre-treatment measurements, ability to tolerate the treatment and the ability of the beneficiary (or caregiver) to apply the device.
  • The medical record does not include documentation by the treating physician supporting the medical necessity of a pneumatic compression device including 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 which have been tried and failed; and the clinical response to an initial treatment with the device.

Pneumatic Compression Device Resources

Updated: 10.05.2026

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