Compression Pump Ordering Process:

Please provide the following 4 Items.

1.  Script:

    • Pneumatic Compression Device Set @ 45mmHg.  2 X per day for 1 hour

2.  Face sheet with insurance information and demographics

3.  Copy of Insurance card(s)

4.  Clinical Notes and Documentation (necessary to process the claim)

    • Diagnosis:  Chronic Lymphedema – 457.1 = I89.0 and 457.0 = I97.2
    • Duration of Condition:  How long has patient had the symptoms?
    • Prognosis:  Fair or worsening
    • Functional Limitations Caused by Condition:  limited mobility, problems with walking, balance and dressing, basic daily functions
    • Prior Remedies Utilized:  Exercise, elevation, compression garments (wraps, or garment) – Minimum of 4 weeks of these conservative therapies.
    • Notes must be signed or electronically signed

We look forward to assisting you, care for your patients.
Please contact us or fax the above information and we will begin the process.
Fax: (888) 398-0031