Does Medicare cover compression garments?

This is a question that we are frequently asked.  The short answer is “No?.  However, there is legislation currently before congress that would direct Medicare to cover compression garments for the treatment of lymphedema.

There is one exception in the current Medicare policy.  Coverage may be provided if you are being treated by a doctor for a venous statis ulcer on your leg and have a prescription from your Doctor for compression stockings and liners for this condition. BrightLife Direct sells two ulcer care stockings, Jobst UlcerCare with Zipper and Sigvaris UlceRx Kit.  Here’s the nitty gritty from Medicare:

The beneficiary must have an open venous stasis ulcer that has been treated by a physician or other healthcare professional requiring medically necessary debridement.  The gradient stocking must be proven to deliver compression greater than 30 mm Hg. and less than 50 mm Hg.  When a covered gradient compression stocking is provided to a patient with an open venous stasis ulcer, the modifier AW (item furnished in conjunction with a surgical dressing) must be appended or the claim will be denied as a non-covered service.  Gradient compression stockings are non-covered for the following conditions:
Venous insufficiency without stasis ulcers
Prevention of stasis ulcers

The Lymphedema Diagnosis and Therapy Cost Saving Act of 2010 (HR4662) was introduced in the House of Representatives by North Carolina Congressman Larry Kissell. This is a bi-partisan effort and currently has 58 co-sponsors in the House.  This bill would establish a new benefit category to cover the compression bandages, compression garments and compression devices used in the treatment of lymphedema.  The Medicare Evidence Development Coverage Advisory Committee (MEDCAC) concluded at their meeting last November that existing evidence gives reasonable confidence that use of compression bandage systems and compression garments improve the health of lymphedema patients.

To read a summary or a the entire bill click here.

You can help get this bill passed by emailing or phoning your congressperson.

Pete@BrightLife Direct
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