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Vasopneumatic Devices

Title: Vasopneumatic Devices

Code: 97016


A Vasopneumatic device is composed of an inflatable garment consisting of multiple pressure compartments that wraps around the arm, leg or a body section and an electrical pneumatic pump that fills the garment with compressed air. The garment is intermittently inflated and deflated with cycle times and pressures that vary between devices.


Specific indications for the use of vasopneumatic devices include reduction of edema after acute injury or lymphedema of an extremity. 

Specific indications for the use of vasopneumatic devices include:

    • Reduction of edema after acute injury
    • Lymphedema of an extremity
    • Education and training on the use of vasopneumatic devices for home use


Education on the use of a lymphedema pump for home use is covered when medically necessary and can typically be completed in three (3) or fewer visits once the patient has demonstrated measurable benefit in the clinic environment.

Further treatment of lymphedema by a vasopneumatic device rendered by a clinician after the educational visits is generally not reasonable and necessary unless the patient presents with a condition or status requiring the skills and knowledge of a physical or occupational therapist.

The use of vasopneumatic devices is generally not covered as a temporary treatment while awaiting receipt of ordered compression stockings.


Supportive Documentation Requirements for 97016

    • Area of the body being treated, location of edema
    • Objective edema measurements (1+, 2+ pitting, girth, etc.), comparison with uninvolved side
    • Effects of edema on function
    • Type of device used
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