`E0673` Pressure pneum appl half leg

Segmental gradient pressure pneumatic appliance, half leg

Medicare coverage: Special coverage instructions apply
Status: active (October 2026 file)

Medically Unlikely Edits (effective October 1, 2026)

Practitioner: max 0 units per day (clinical), rationale: CMS Policy
Outpatient hospital: max 0 units per day (clinical), rationale: CMS Policy
DME supplier: max 2 units per day (policy), rationale: Anatomic Consideration

Medicare pricing for E0673

DMEPOS fee schedule, July 2026 (DME26-C)

NU (purchased, new), inexpensive or routinely purchased (IN): non-rural $382.16 in the contiguous states; $382.16 to $458.61 in AK, HI, PR and VI; ceiling $382.16, floor $324.84
RR (rental), inexpensive or routinely purchased (IN): non-rural $38.22 in the contiguous states; $38.22 to $45.88 in AK, HI, PR and VI; ceiling $38.22, floor $32.49
UE (purchased, used), inexpensive or routinely purchased (IN): non-rural $286.68 in the contiguous states; $286.68 to $343.97 in AK, HI, PR and VI; ceiling $286.68, floor $243.68

Payer policies and prior authorization for E0673

35 of 36 payer prior-auth lists that name E0673 require prior authorization or set conditions: Blue Cross and Blue Shield of Texas, CarePlus Health Plans, Humana, Molina Complete Care (Virginia), Molina Healthcare of Arizona, Molina Healthcare of California, Molina Healthcare of Florida, Molina Healthcare of Idaho, Molina Healthcare of Iowa, Molina Healthcare of Michigan, Molina Healthcare of Nevada, Molina Healthcare of New Mexico, Molina Healthcare of Ohio, Molina Healthcare of South Carolina, Molina Healthcare of Texas, Molina Healthcare of Utah, Molina Healthcare of Washington, Molina Healthcare of Wisconsin, Molina Healthcare, Inc. (national grid), Rocky Mountain Health Plans, and others.

Payer	Plan	State	Prior auth	Conditions	Since	Source
Blue Cross and Blue Shield of Texas	Texas PA exemption (gold card), outpatient, fully insured	TX	prior auth required	Gold-card exemption available	Jul 1, 2026	BCBSTX Outpatient Prior Authorization Exemption Clinical Guidelines (max units, PA exempt date range)
CarePlus Health Plans	CarePlus Health Plans	FL	prior auth required		Jan 1, 2027	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List
Humana	Humana D-SNP (FL)	FL	prior auth required		Jan 1, 2027	1 *New prior authorization requirement 787403FL0725 FLHMQSREN Humana Dual Fully Integrated Florida Prior Authorization and Notification List
Humana	Humana D-SNP (IL)	IL	prior auth required		Jan 1, 2027	Humana Dual Fully Integrated Illinois Prior Authorization and Notification List
Humana	Humana D-SNP (IN)	IN	prior auth required		Jan 1, 2027	*New prior authorization requirement 814403IN0825 H4939_INHN6Z6EN_C Humana PathWays Dual Care (HMO-POS D-SNP) Indiana Prior Authorization and Notification List
Humana	Humana D-SNP (MI)	MI	prior auth required		Jan 1, 2027	1 Humana Dual Highly Integrated Michigan Prior Authorization and Notification List
Humana	Humana D-SNP (SC)	SC	prior auth required		Jan 1, 2027	Humana Dual Highly Integrated South Carolina Prior Authorization and Notification List
Humana	Humana D-SNP (VA)	VA	prior auth required		Jan 1, 2027	Virginia Prior Authorization and Notification List
Humana	Humana D-SNP (VA)	VA	prior auth required		Jan 1, 2027	Virginia Prior Authorization and Notification List
Humana	Humana Healthy Horizons	IL	prior auth required		Jan 1, 2027	Humana Healthy Horizons in Illinois Prior Authorization and Notification List To view -specific medical coverage policies, please visit Humana Healthy Horizons in Illinois Clinical coverage policies .
Humana	Humana Healthy Horizons	IN	prior auth required		Jan 1, 2027	1 Humana Healthy Horizons® in Indiana Preauthorization and Notification List (PAL) for Indiana PathWays for Aging Please note the term prior authorization when used in this communication, is defined a
Humana	Humana Healthy Horizons	VA	prior auth required		Jan 1, 2027	Humana Healthy Horizons in Virginia Prior Authorization and Notification List (PAL)
Humana	Humana MA and D-SNP	All	prior auth required		Jan 1, 2027	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List
Humana	Humana Puerto Rico MA and Dual Medicare-Medicaid	PR	prior auth required		Nov 3, 2025	Puerto Rico Medicare Advantage and Dual Medicare-Medicaid Plans Preauthorization and Notification List Puerto Rico Medicare Advantage and Dual Medicare-Medicaid Plan Preauthorization and Notification
Humana	Oak Street Health	All	prior auth required			Oak Street Health (Humana): Prior Authorization List (PAL) Codes Under Management
Molina Complete Care (Virginia)	Medicare-only PA matrix for D-SNP	VA	prior auth required		Jan 1, 2022	Medicare Prior Auth (PA) Code Matrix (Virginia), effective Q1 2022
Molina Healthcare of Arizona	Medicare-only PA matrix for D-SNP	AZ	prior auth required		Jan 1, 2022	Medicare Prior Auth (PA) Code Matrix (Arizona), effective Q1 2022
Molina Healthcare of California	Medicare Advantage	CA	prior auth required		Jul 1, 2021	Medicare Prior Auth (PA) Code Matrix (California), effective Q3 2021
Molina Healthcare of Florida	Medicare Advantage	FL	prior auth required		Apr 1, 2021	Medicare Prior Auth (PA) Code Matrix (Florida), effective Q2 2021
Molina Healthcare of Idaho	Medicare Advantage	ID	prior auth required		Apr 1, 2021	Medicare Prior Auth (PA) Code Matrix (Idaho), effective Q2 2021
Molina Healthcare of Iowa	Medicaid	IA	prior auth required		Jul 1, 2023	IA Prior Authorization Matrix, effective Q3 2023
Molina Healthcare of Michigan	Exchange	MI	prior auth required		Jul 1, 2021	Molina Healthcare of Michigan PA Matrix, effective 7/1/2021
Molina Healthcare of Nevada	Medicaid	NV	prior auth required		Oct 1, 2022	Medicaid Prior Auth (PA) Code Matrix, effective Q4 2022
Molina Healthcare of New Mexico	Medicare Advantage	NM	prior auth required		Jan 1, 2021	Medicare Prior Auth (PA) Code Matrix (New Mexico), effective Q1 2021
Molina Healthcare of Ohio	Medicaid and MyCare Ohio (MMP) Medicaid	OH	prior auth required		Oct 1, 2023	Molina Healthcare of Ohio Prior Authorization (PA) Code List, effective 2023-10-01
Molina Healthcare of Ohio	Medicare and MyCare Ohio (MMP) Medicare	OH	prior auth required		Oct 1, 2023	Molina Healthcare of Ohio Prior Authorization (PA) Code List, effective 2023-10-01
Molina Healthcare of Ohio	Exchange	OH	prior auth required		Oct 1, 2023	Molina Healthcare of Ohio Prior Authorization (PA) Code List, effective 2023-10-01
Molina Healthcare of South Carolina	Medicare Advantage	SC	prior auth required		Apr 1, 2021	Medicare Prior Auth (PA) Code Matrix (South Carolina), effective Q2 2021
Molina Healthcare of Texas	Exchange	TX	prior auth required	PA Modernization - PA requirements will be removed where covered	Jan 1, 2024	Marketplace Prior Authorization (PA) Code Matrix (Texas), effective July 1, 2026
Molina Healthcare of Utah	Medicare Advantage	UT	prior auth required		Apr 1, 2021	Medicare Prior Auth (PA) Code Matrix (Utah), effective Q2 2021
Molina Healthcare of Washington	Medicare Advantage	WA	prior auth required		Apr 1, 2021	Medicare Prior Auth (PA) Code Matrix (Washington), effective Q2 2021
Molina Healthcare of Wisconsin	Medicare Advantage	WI	prior auth required		Oct 1, 2021	Medicare Prior Auth (PA) Code Matrix (Wisconsin), effective Q4 2021
Molina Healthcare, Inc. (national grid)	Molina national (MHI) Medicare grid	All	prior auth required		Oct 1, 2021	Medicare Prior Auth (PA) Code Matrix (national), effective Q4 2021
Rocky Mountain Health Plans	Rocky Mountain Medicare Advantage D-SNP	CO	prior auth required		Feb 1, 2025	Rocky Mountain Health Plans Medicare Advantage Dual-Special Needs Plans – prior authorization Effective February 1, 2025
UnitedHealthcare	Preferred Care Network and Preferred Care Partners of Florida	FL	prior auth required		Oct 1, 2026	Prior authorization requirements for Preferred Care Network and Preferred Care Partners of Florida Effective October 1, 2026

Payer coverage policies that name E0673

E0673 appears in 31 coverage policies from Aetna, Anthem, Blue Cross & Blue Shield of Mississippi, Blue Cross Blue Shield of Massachusetts, Blue Shield of California, BlueCross BlueShield of South Carolina, Capital Blue Cross, Cigna, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT), Premera Blue Cross, Regence, UnitedHealthcare.

Payer	Policy	Role in policy	Reviewed	Document
Aetna	Compression Garments for the Legs (0482)	covered if criteria are met	Jul 29, 2026	payer document
Aetna	Cryoanalgesia and Therapeutic Cold (0297)	not covered	Apr 14, 2026	payer document
Aetna	Intermittent Pneumatic Compression Devices (0500)	covered if criteria are met	Jul 10, 2026	payer document
Aetna	Lymphedema (0069)	covered if criteria are met	Feb 25, 2026	payer document
Anthem	Compression Devices for Lymphedema (CG-DME-06)	covered if criteria are met	Nov 6, 2025	payer document
Anthem	Compression Devices for Lymphedema (CG-DME-06)	not covered	Nov 6, 2025	payer document
Anthem	Pneumatic Compression Devices for Prevention of Deep Vein Thrombosis of the Extremities in the Home Setting (CG-DME-46)	not covered	May 14, 2026	payer document
Blue Cross & Blue Shield of Mississippi	Pneumatic Compression Pumps For Treatment Of Lymphedema And Venous Ulcers	covered if criteria are met		payer document
Blue Cross & Blue Shield of Mississippi	Postsurgical Home Use Of Limb Compression Devices For Venous Thromboembolism Prophylaxis	covered if criteria are met (range E0650-E0675)		payer document
Blue Cross Blue Shield of Massachusetts	Pneumatic Compression Pumps for Treatment of Lymphedema (354)	listed, no stance		payer document
Blue Shield of California	Compression Pumps for Treatment of Lymphedema and Venous Ulcers (1.01.18)	listed, no stance		payer document
Blue Shield of California	Postsurgical Home Use of Limb Compression Devices for Venous Thromboembolism Prophylaxis (1.01.28)	listed, no stance		payer document
BlueCross BlueShield of South Carolina	Compression Pumps for Treatment of Lymphedema and Venous Ulcers (CAM 10118) E0665 \| Non-segmental pneumatic appliance for use with pneumatic compressor, full arm	listed, no stance	May 1, 2026	payer document
BlueCross BlueShield of South Carolina	Postsurgical Home Use of Limb Compression Devices for Venous Thromboembolism Prophylaxis (CAM 10128)	listed, no stance (range E0650-E0673)	Aug 1, 2026	payer document
Capital Blue Cross	Compression Devices for Treatment of Lymphedema and Peripheral Vascular Disease (MP 6.013) Procedure Codes	covered if criteria are met	Sep 1, 2026	payer document
Cigna	Compression Devices (0354)	covered if criteria are met	May 15, 2026	payer document
Health Care Service Corporation (BCBS IL, TX, OK, NM, MT)	Compression Pumps for Treatment of Lymphedema and Venous Ulcers (MED202.060) HCPCS Codes A4600, E0650, E0651, E0652, E0655, E0656, E0657, E0658, E0659, E0660,	listed, no stance	Jan 1, 2026	payer document
Health Care Service Corporation (BCBS IL, TX, OK, NM, MT)	Postsurgical Home Use of Limb Compression Devices for Venous Thromboembolism Prophylaxis (MED202.073) HCPCS Codes A4600, E0650, E0651, E0652, E0655, E0660, E0665, E0666, E0667, E0668,	listed, no stance	Sep 1, 2026	payer document
Premera Blue Cross	Compression Pumps for Treatment of Lymphedema and Venous Ulcers (1.01.18) Multichamber Programmable Appliances (used in conjunction with E0652)	covered if criteria are met	Sep 21, 2026	payer document
Regence	Postsurgical Home Use of Limb Compression Devices (Durable Medical Equipment 90)	listed, no stance (range E0650-E0673)	Dec 1, 2025	payer document
UnitedHealthcare	Pneumatic Compression Devices (2026T0563X)	listed, no stance	Jun 1, 2026	payer document
UnitedHealthcare	Pneumatic Compression Devices (CS097.T)	listed, no stance	Jul 1, 2026	payer document
UnitedHealthcare	Pneumatic Compression Devices (for Idaho Only) (CS097ID.E)	listed, no stance	Aug 1, 2026	payer document
UnitedHealthcare	Pneumatic Compression Devices (for Kansas Only) (CS097KS.04)	listed, no stance	Jul 1, 2026	payer document
UnitedHealthcare	Pneumatic Compression Devices (for Kentucky Only) (CS097KY.10)	listed, no stance	Jul 1, 2026	payer document
UnitedHealthcare	Pneumatic Compression Devices (for Nebraska Only) (CS097NE.T)	listed, no stance	Aug 1, 2026	payer document
UnitedHealthcare	Pneumatic Compression Devices (for New Jersey Only) (CS097NJ.S)	listed, no stance	Jul 1, 2026	payer document
UnitedHealthcare	Pneumatic Compression Devices (for New Mexico Only) (CS097NM.D)	listed, no stance	Jul 1, 2026	payer document
UnitedHealthcare	Pneumatic Compression Devices (for North Carolina Only) (CSNCT0563.09)	listed, no stance	Jul 1, 2026	payer document
UnitedHealthcare	Pneumatic Compression Devices (for Ohio Only) (CS097OH.E)	listed, no stance	Jul 1, 2026	payer document
UnitedHealthcare	Pneumatic Compression Devices (for Pennsylvania Only) (CS097PA.S)	listed, no stance	Jul 1, 2026	payer document
UnitedHealthcare	Pneumatic Compression Devices (for Tennessee Only) (CS097TN.T)	listed, no stance	Jul 1, 2026	payer document

Recent prior-auth changes

Jan 1, 2027: PA added, Humana
Aug 1, 2026: PA removed, HealthSpring
Feb 1, 2026: PA added, UnitedHealthcare
Feb 1, 2026: PA added, uhc:pa:summary-of-changes
Jan 1, 2026: PA removed, Molina Healthcare of Michigan
Mar 1, 2025: PA removed, Rocky Mountain Health Plans
Feb 19, 2025: PA removed, Molina Healthcare of Texas
Feb 19, 2025: PA removed, Molina Healthcare of Texas
Jan 1, 2025: PA removed, Molina Healthcare of Texas
Jul 1, 2024: PA removed, Blue Shield of California Promise Health Plan

Medicaid fee-for-service

Prior authorization required or conditional in CO, LA, MA, MS, NY, OH, VA, WV.

AZ: $443.04 (dme), effective Oct 1, 2026
CO: $0.00 (dme), effective Jul 1, 2026
IL: $178.35 (dme), effective Jan 1, 2026
IN: $31.85 (professional, Advanced Practice Nurse (85%), non-facility), effective Jan 1, 2026
KY: $256.56 (dme), effective Jan 1, 2026
LA: $263.93 (dme), effective May 1, 2014
MD: $32.48 (dme), effective Apr 1, 2026
MS: $30.57 (comprehensive), effective Jul 1, 2026
NE: $33.44 (dme), effective Jul 1, 2026
NY: $285.30 (dme), effective Jul 1, 2026
OH: $299.73 (dme), effective Jan 1, 2026
OK: $382.16 (dme), effective Jan 1, 2026
TX: $23.53 (dmepos_tos_9_e_j_l_and_r, Ccp Provider), effective Apr 1, 2013
VA: $343.94 (dme), effective Dec 1, 2026
VT: $320.34 (outpatient_hospital_opps), effective Feb 1, 2026
WY: $0.00 (outpatient_hospital_apc, Children's Hospitals), effective Apr 1, 2026

From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.

E0673 Pressure pneum appl half leg