HCPCS E0652: Pneumatic compressor, segmental home model

Be more informed of the documentation and billing requirements needed to properly use and bill HCPCS code E0652, from our short guide.

Use Code

## **What is HCPCS code E0652?** HCPCS code E0652, is a code with a description: "pneumatic compressor, segmental home model with calibrated gradient pressure," that falls under Durable Medical Equipement (DME), specifically pneumatic compressors and appliances. It refers to a pneumatic compressor, segmental home model with calibrated gradient pressure which is a high-precision pneumatic compression device designed for home use. The equipment delivers pressurized air through multiple independently controlled segments of an appliance (e.g., sleeves) with clinician-adjustable, calibrated pressure gradients. This capability enables tailored compression according to individual patient needs—particularly useful in cases involving scarring, contractures, or complex truncal or chest lymphedema.

## **HCPCS code E0652 documentation requirements** The required documentation generally includes: - **Treating practitioner's documentation**: A prescription from an authorized practitioner (MD, DO, DPM, NP, PA, CNS). - **Diagnosis and prognosis**: The patient's diagnosis of lymphedema, its severity (e.g., through objective measurements with bilateral comparison), and prognosis. - **Failed conservative therapy trial**: Documentation of a prior four-week trial of conservative therapy (for lymphedema) that failed to produce satisfactory results. This trial must include: regular and compliant use of an appropriate compression bandage system or garment with adequate graduated compression and regular exercise and elevation of the limb. - **Failed trial of less complex device**: The patient must have failed an appropriate four-week trial of a less complex pneumatic compression device (E0650 or E0651). - **Lymphedema extending to torso**: Clear documentation that the lymphedema extends onto the chest, trunk, and/or abdomen, and this torso lymphedema has failed to improve with the trial of a simpler device.

## **E0652 billing requirements** E0652 is covered only under restrictive conditions: - **Modifiers**: Modifiers such as the following are appended as needed: NU (purchase of new equipment), RR (rental of equipment—billed monthly), or UE (purchase of used equipment) are common. - **Place of Service (POS**): The POS code should be the location where the device is intended for use, typically the patient's home (POS 12). - **Required forms**: While Certificate of Medical Necessity (CMN) forms have largely been replaced by detailed supporting medical records, the supplier must have a valid Standard Written Order (SWO) and proper Proof of Delivery (POD). - **Payment Basis**: Payment is made only if the item is determined to be reasonable and necessary under the payer's coverage criteria (e.g., Medicare's national coverage determinations and local coverage determinations).

## **Other relevant codes** - **E0650**: Pneumatic compressor, non-segmental home model - **E0651**: Pneumatic compressor, segmental home model without calibrated gradient pressure - **E0656**: Segmental pneumatic appliance for use with pneumatic compressor trunk. - **E0657**: Segmental pneumatic appliance for use with pneumatic compressor, chest. - **E0667**: Segmental pneumatic appliance for use with pneumatic compressor, full leg.

Frequently asked questions

No. For most payers, including Medicare, E0652 is generally covered only when the lymphedema extends to the chest, trunk, and/or abdomen and has not been successfully treated with a simpler device (E0650 or E0651). It is typically denied as not medically necessary for lymphedema of the extremities alone.

No. Medicare and many other payers generally do not cover E0652 for the treatment of CVI with venous stasis ulcers. Simpler pumps (E0650 or E0651) may be covered for CVI if specific medical necessity criteria are met, but not E0652.

E0651 is a segmental home model pneumatic compressor without calibrated gradient pressure. E0652 is the higher-level segmental compressor with calibrated gradient pressure. This "calibrated gradient pressure" means the device has manual control of the pressure in each chamber, allowing for a more sophisticated, individualized compression treatment. The difference in features often dictates which conditions they are covered for.