The History of Lymphedema Pumps

Jackie's Dilemma

Jackie posted this message, “I was SO excited that my insurance company said they would pay 100% for a lymphedema pump when FlexiTouch inquired about it. But, when they received the claim, they denied it. They said that "there was not enough data to validate the superiority of the programmable pump over the non-programmable pump."

The Flexitouch seems to be a PERFECT solution and therefore my question is, “What exactly does programmable refer to?” “What pumps are NOT programmable?” and “Are they any good?”

Jackie’s dilemma and questions are shared my many Lymph Notes members and we are delighted that Bob Weiss, the LymphActivist, posted the history of this perplexing problem plus helpful suggestions.  

*** Error: missing image ***Bob’s Message

The answer to your question is very complex. Before trying to make some sense of the "pump" situation I would like to talk about the history of Medicare reimbursement for pumps, because that is the background of all insurance company reimbursement policies.

The original pumps were single-chamber pumps which just applied a constant pressure on the entire limb with an inflatable single chamber sleeve. They were found to be beneficial for edema due to venous insufficiency, where the swelling was caused by an inability of the venous system to remove fluid from the limb. By increasing the tissue pressure over the entire limb, the fluid was forced back into the veins and returned to the heart.

Then someone found that by constructing a sleeve with more than one chamber, and adjusting the pressure at the ankle to be greater than the pressure at the thigh, a graduated tissue pressure was more effective. Again, this was effective for edema caused by venous insufficiency. This still only required one simple pump and a multi-segment sleeve.

The next development addressed edema caused by a problem in the lymphatic system, and used a multi-chambered pump attached to a multi-segmented sleeve which allowed the pressure to be graduated and sequentially applied from the toes to the thigh. These allowed the specific pressure applied to the leg to be tailored to the specific problem, and also provided some "working" action on fibrotic areas.

Recognizing that the lymphatic fluid was just being "dumped" into the tissue just outside of the sleeve, some manufacturers developed body garments which would drain the torso in preparation for treatment of the limb.

With each advance, the pumps and garments became more complex and more expensive as they became more effective. Medicare and insurance companies have taken the desire to pay for only the minimum effective version of the pump and turned it into a policy which demands that the cheapest pump be used and found to be either ineffective or harmful. Then they will authorize the medically appropriate more expensive pump.

Suggested Action

Find a doctor who understands this, does a differential diagnosis of your particular swelling (venous? lymphatic? combined? stage? co-conditions?) and prescribes the appropriate pump for your condition. Stage 1 and early stage 2 lymphedema will probably benefit from MLD and compression garments, and possibly a sequential graduated pneumatic pump. Stage 3 lymphedema and lymphaticovenous edema, where the lymphatics are no longer functional or the edema is due to venous insufficiency might do better with a cheaper graduated compression, non-sequential or sequential pump.

Flexitouch Pump. Photo courtesy of Tactile Systems

Contact the Flexitouch people. They can amplify on what I have just told you.

As far as evidence goes, I suggest that you tell your insurance company that at a meeting on November 18, 2009 of the Medicare Evidence Development Coverage Advisory Committee (MEDCAC) determined that there is moderate confidence that the evidence DOES SUPPORT the use of programmable pneumatic pumps  independently, or as an adjunct to CDT in the treatment of lymphedema.

I suggest that you request a letter of medical necessity from your physician based on your medical need and specifically specifying the pump needed for your condition, and then request an Independent Medical Review of your case.

Our thanks to Bob Weiss, the LymphActivist, for writing this response in January 2010.

Got a question or comment? Post in the 'Insurance, Medicare' forum.
Category: Insurance and Medicare Updated: 2010-01-12