CMS-846 PNEUMATIC COMPRESSION DEVICES Preview on Page 1

CMS-846 PNEUMATIC COMPRESSION DEVICES 2026

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  1. Click ‘Get Form’ to open the CMS-846 in the editor.
  2. In Section A, select the appropriate certification type (Initial, Revised, or Recertification) and enter the required dates. Fill in the patient’s name, address, telephone number, and Medicare ID.
  3. Provide your supplier information including name, address, telephone number, and NSC or NPI number. Specify the place of service and list all procedure codes for items ordered.
  4. Complete Section B by estimating the length of need in months and entering diagnosis codes. Answer questions 1-5 regarding medical necessity by checking 'Y' for Yes or 'N' for No.
  5. In Section C, describe all items ordered along with their costs. Ensure this section is completed by the supplier.
  6. Finally, Section D requires the physician's attestation. The physician must sign and date this section to certify that all information is accurate.

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Pneumatic Compression Devices (PCDs) are covered under the Durable Medical Equipment benefit (Social Security Act 1861(s)(6)). In order for a beneficiarys equipment to be eligible for reimbursement, the reasonable and necessary (RN) requirements set out in the related Local Coverage Determination must be met.
It can reduce pain and swelling associated with poor circulation. Stockings, bandages and inflatable wraps are examples of compression therapy devices.
Pneumatic compression devices are a treatment option for patients with lymphedema who have failed conservative measures. These devices consist of an inflatable garment for the arm, leg, trunk, or chest and an electrical pneumatic pump that fills the garment with compressed air.
Pneumatic lymphedema pumps can cost from $600 to $5,000.
Some people with certain health conditions should not use IPC devices. For example, people with leg ulcers, burns, or peripheral vascular disease have a higher risk for problems. Older adults may be more at risk for skin breakdown.

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certificate of medical necessity cms-846

Form CMS-846 (09/05). Page 2. INSTRUCTIONS FOR COMPLETING THE CERTIFICATE OF MEDICAL NECESSITY. FOR PNEUMATIC COMPRESSION DEVICES (CMS-846). SECTION A: (May be

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