application of vasopneumatic devices (code 97016) is covered only in the case
post-mastectomy lymphedema syndrome
is needed for a diagnosis code different from those listed above,
preauthorization should be requested.
limited to three treatments. If additional treatments are needed, the provider
will need to justify the need for additional treatment by documenting unusual
circumstances preventing self-treatment at home.
additional treatments past three will be granted only:
context of a plan for transition to self-management at home; OR
In the case
that home treatment is not possible.
treatments authorized must be handled as an override; the claims will have to be
submitted to Care Management and hand carried through the claims adjudication
Codes Used In This BI:
Vasopneumatic Device Therapy