Starting April 13, 2026, Medicare will initiate prior-authorization reviews for pneumatic compression devices (lymphedema pumps).
To understand what this might mean for you, here is some basic information:
What is prior authorization?
Prior authorization is a requirement set by an insurance company to obtain pre-approval for a service, treatment, or prescription before it is provided.
When does this start?
Starting April 13, 2026, Medicare will initiate prior authorization reviews for both basic and advanced lymphedema pumps (HCPCS E0651 and E0652).
How will this impact pneumatic compression device access for Medicare beneficiaries?
Once Medicare receives all required documentation, it usually takes about 5–7 business days for Medicare to decide if a beneficiary meets the requirements for a lymphedema pump. Once Medicare gives approval, the supplier is able to move forward with the shipment process.
What happens if Medicare denies the prior authorization request?
In the event that Medicare denies prior authorization, a supplier may request additional information from the beneficiary’s healthcare team and/or the beneficiary may need to schedule a follow-up visit with their provider for an additional assessment. The supplier can resubmit a prior authorization to Medicare after receipt of updated information.
If I have additional questions, who should I ask?
Please reach out to your pneumatic compression device supplier with additional questions. If you have recently been prescribed a pump and need help finding a supplier, please visit our Lymphedema Supplier directory.
As a reminder, on Tuesday, March 31 at 12:00 noon Eastern time, we are pleased to welcome L&R USA as the featured guest for our next Industry Partner Product Education Series Webinar.
We hope you can join us for this informative event. A recording will be available for those who cannot attend live.
Heather Ferguson
Founder & Executive Director
Lymphedema Advocacy Group
LymphedemaAdvocacyGroup.org
