Payer Requirements and Reimbursement

General Guidelines for Coverage by Insurers

Most Insurance plans provide coverage of Compression Devices and Appliances provided by Wright therapy Products, Inc.

  • E0652 – Wright 52 Gradient Pneumatic Compression Pump
  • E0651 – Wright 51 Non-Gradient Pneumatic Compression Pump
  • E0667 – Leg extremity (leg) appliance
  • E0668 – Upper extremity (arm) Appliance

 

Medicare:

Covers Calibrated Gradient Compressors and Appliances for the treatment of:

– Venous Insufficiency/Venous Ulcer

  • Must document that other treatments, such as bandaging, compression stockings and exercise
  • Failed to heal the wound for six consecutive months

– Lymphedema- Congenital, secondary, and post-mastectomy

  • Must document that conservative therapy including the use of an E0651 not- calibrated gradient compressor, was tried and was not effective

NOTE: Medicare and many commercial insurers require extensive and precise treatment notes from the patient’s medical record to approve coverage of an E0652

 

Commercial Insurers:

Most commercial Insurers cover calibrated Gradient compression Pumps and Appliances for the treatment of:

– Venous Insufficiency/Venous Ulcers

– Lymphedema – Congenital, secondary, post-mastectomy, and other lymphedema

– Other edematous conditions

Many have adopted Medicare coverage and documentation guidelines.

To request an insurance coverage evaluation call 800-631-9535 or  fax the following information to 724-695-0406:

  • Insurance Information, i.e. Copy of the patient insurance card
  • Patient Information, name phone, diagnosis, permission to contact, etc.
  • Physicians order, prescription, and or treatment notes

NOTE: The guidelines above are general and do not assure coverage.