Coverage depends on your plan and medical documentation.
Waypoint reviews your benefits and payer requirements before delivery and lets you know what, if anything, you may be responsible for.
The lymphedema pathway
Traditional Medicare has specific coverage requirements for home pneumatic compression therapy. These include a documented diagnosis and clinical findings, a four-week trial of appropriate conservative therapy, continued symptoms or need after that trial, and physician-directed care.
Waypoint reviews the submitted record against the applicable Medicare requirements and lets the referring office know if additional information is needed.
Four weeks means documented treatment
The medical record should support the conservative therapy actually performed and the patient's response. The passage of four weeks alone does not establish that the coverage requirements have been met.
Prior authorization for E0651 and E0652
E0651 and E0652 are subject to Medicare prior authorization for dates of service beginning April 13, 2026. Waypoint coordinates the authorization process as part of the DME workflow and works with the referring office when additional documentation is required.
A separate pathway
Medicare applies different coverage criteria to chronic venous insufficiency of the lower extremities. Home pneumatic compression coverage generally requires one or more venous stasis ulcers that have failed to heal after a six-month trial of physician-directed conservative therapy.
Waypoint reviews each referral against the applicable pathway.
Do not assume Medicare's rules apply
Commercial and Medicare Advantage plans may have different medical-necessity criteria, authorization requirements, documentation rules and network requirements.
Waypoint reviews the applicable requirements for each patient rather than assuming one payer's rules apply to another.
How cost conversations work
Waypoint reviews available insurance benefits before delivery and lets the patient know what, if anything, they may be responsible for. Coverage and patient responsibility depend on the individual plan and medical record.
Benefits verification is not a guarantee of coverage or payment.
This page is general information
Medicare and commercial payer requirements change. Nothing here is a benefit determination, a guarantee of payment, or a statement about any individual patient's coverage. We review each case against the requirements in effect for that patient's plan.