HCPCS Level II › E codes E0678 Non pneum seq comp full legNon-pneumatic sequential compression garment, full leg
Medicare coverage: Carrier judgment Status: active (October 2026 file) Medicare pricing for E0678 DMEPOS fee schedule, July 2026 (DME26-C) RR (rental), capped rental (CR): non-rural $39.22 to $46.14 in the contiguous states; $46.14 to $105.43 in AK, HI, PR and VI Payer policies and prior authorization for E0678 17 of 17 payer prior-auth lists that name E0678 require prior authorization or set conditions: CarePlus Health Plans, Cigna, Humana.
Payer Plan State Prior auth Conditions Since Source Cigna ACA/IFP All prior auth required May be delegated to eviCore for some clients Jan 1, 2024 Master Precertification List (For Health Care Providers) Cigna Basic Standard All prior auth required May be delegated to eviCore for some clients Jan 1, 2024 Master Precertification List (For Health Care Providers) Cigna Complete/PHS+/Preferred All prior auth required May be delegated to eviCore for some clients Jan 1, 2024 Master Precertification List (For Health Care Providers) Cigna Durable Medical Equipment All prior auth required Experimental/investigational Mar 7, 2026 Cigna Commercial Comprehensive CPT Code Reference for Prior Authorization Across All Programs Cigna Durable Medical Equipment All prior auth required Experimental/investigational; Intake only if requested as SAR Payer Mar 7, 2026 Cigna Commercial Prior Authorization Procedure Code List: Durable Medical Equipment 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 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
Payer coverage policies that name E0678 E0678 appears in 10 coverage policies from Aetna, Anthem, Blue Cross & Blue Shield of Mississippi, Blue Shield of California, Capital Blue Cross, Cigna, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT), Premera Blue Cross, Regence.
Payer Policy Role in policy Reviewed Document Aetna Lymphedema (0069) not covered Feb 25, 2026 payer document Anthem Compression Devices for Lymphedema (CG-DME-06) covered if criteria are met Nov 6, 2025 payer document Blue Cross & Blue Shield of Mississippi Garments (L.1.04.400) covered if criteria are met 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 Shield of California Compression Pumps for Treatment of Lymphedema and Venous Ulcers (1.01.18) listed, no stance 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) unproven / investigational 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 Premera Blue Cross Compression Pumps for Treatment of Lymphedema and Venous Ulcers (1.01.18)Nonpneumatic Compression Appliances 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 Dec 1, 2025 payer document
Recent prior-auth changes Jan 1, 2027: PA added, Humana Jul 1, 2026: PA removed, HealthSpring Jul 1, 2024: PA removed, Blue Shield of California Promise Health Plan Jan 1, 2024: PA added, humana:pa:commercial Jan 1, 2024: PA added, Blue Shield of California Promise Health Plan Medicaid fee-for-service Prior authorization required or conditional in CO, MA, NY, WA.
AZ: $1.78 (dme_rentals), effective Oct 1, 2026 CO: $32.03 (health_first_colorado), effective Jul 1, 2026 IN: $326.82 (professional, Advanced Practice Nurse (85%), non-facility), effective Jan 1, 2026 NY: $344.46 (dme), effective Jul 1, 2026 OH: $318.00 (dme), effective Jan 1, 2024 VT: $345.21 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $461.40 (medical_equipment_supplies), effective Jul 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.