## **What is HCPCS code E0651?**
HCPCS code, with a description of "Pneumatic compressor, segmental home model without calibrated gradient pressure," identifies a type of Pneumatic Compression Device (PCD) used in the home setting. A PCD consists of an electric pump and an inflatable appliance (sleeve/garment).
The equipment, in particular, has multiple air chambers (segments) that sequentially inflate and deflate. "Without calibrated gradient pressure" means either the same pressure is present in each segment or there is a fixed, non-adjustable pressure gradient across the segments, as opposed to a device where the pressure in each segment can be individually set or adjusted by the user.
The code is typically covered for the treatment of chronic and severe lymphedema (primary or secondary) of an extremity and chronic venous insufficiency (CVI) with venous stasis ulcers of the lower extremities.
## **HCPCS code E0651 documentation requirements**
Coverage for E0651 is highly dependent on thorough documentation that establishes medical necessity. The medical record must contain:
- **Diagnosis and prognosis**: The patient's diagnosis must be one of the covered conditions (Lymphedema or CVI with ulcers). Edema from other causes is usually not covered.
- **Severity**: Symptoms and objective findings, including measurements (e.g., limb circumference) that establish the severity of the condition.
- **Reason for device**: Documentation must specify why the device is required, including the treatments that have been tried and failed.
- **Trial of conservative therapy**: The medical record must document that the patient has undergone an adequate trial of conservative therapy—typically at least four weeks—consisting of treatments such as elevation, exercise, manual lymphatic drainage, and compression bandaging or garments, and that these measures failed to adequately reduce or control the lymphedema or venous stasis ulcers.
Note that a Standard Written Order (SWO) and Proof of Delivery (POD) may be required documents by payers.
## **HCPCS code E0651 billing requirements**
To properly bill for HCPCS code E0651, the following guidelines must be considered:
- **DME benefit**: E0651 is billed under the Durable Medical Equipment (DME) benefit.
- **Correct coding**: The compressor and its corresponding inflatable appliances (sleeves/garments) must be billed separately using the appropriate HCPCS codes.
- **Modifiers**: Appropriate modifiers may be required based on the claim type (e.g., rental vs. purchase) and payer rules.
- **Coverage limits**: Pneumatic compression devices such as E0651 have a reasonable useful lifetime (RUL) of five years under Medicare guidelines. However, replacement within this period is only covered if the device is lost, stolen, or irreparably damaged due to a specific incident, or if the equipment is no longer repairable and medical necessity still exists. Replacement solely due to wear and tear before the five-year RUL has elapsed is not covered.
## **Other relevant codes**
Related HCPCS codes in the pneumatic compression family include:
- **E0650**: Pneumatic compressor, non-segmental home model (uniform single-port design)
- **E0652**: Pneumatic compressor, segmented home model with calibrated gradient pressure
- **E0655**: Non-segmental pneumatic appliance for use with compressor, half arm
- **E0667**: Segmental pneumatic appliance, full leg (used with E0651)
- **E0668**: Segmental pneumatic appliance, full arm (used with E0651)
- **E0669**: Segmental pneumatic appliance, half leg (used with E0651)
- **A4600**: Sleeve for intermittent limb compression device, replacement onl
- **E0675**: Pneumatic compression device, high pressure, rapid inflation/deflation cycle, for arterial insufficiency (unilateral and bilateral system)
- **E0660**: Non-segmental pneumatic appliance for use with pneumatic compressor, full leg
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