Diagnosis: Lymphedema
Treatment: Pneumatic compression device

The Pneumatic compression device is not medically necessary.

There is no evidence that the Flexitouch is superior to single channel pumps in the management of lymphedema. The trials of these devices are of poor quality, small samples and of short duration. The one RTC (randomized controlled trial) that demonstrated a benefit to this system was unblinded and industry-sponsored. A second study found no improvement with a multi-channel Flexitouch pump over single channel pump. Therefore, there is no evidence to support the routine upfront use of a Flexitouch device over non segmental pumps. With the advent of total decongestive therapy, the use of pumps has fallen out of favor, and they are generally no longer used. There are still situations where pumps may be used; however there is no reliable evidence that a Flexitouch system is superior to single channel pumps in the management of these patients.

This device should be offered for coverage with a trial and failure of a single channel pump for this patient, as the health plan asserts.