Answers to compression garments

Posted by:  :  Category: Medicare

Thanks for all of the responses, this information helps! 1. Currently, Medicare, and consequently many other policies, do not cover one of the critical components of lymphedema treatment, the medically necessary compression supplies used daily in lymphedema treatment. As a result, many patients suffer from recurrent infections, progressive degradation in their condition and eventual disability because they cannot afford the compression supplies required to maintain their condition. 2. Although this legislation relates specifically to a change in Medicare law, it would set a precedent for Medicaid and private insurers to follow. States have already recognized that coverage for comprehensive treatment is essential and cost saving, and are beginning to require that private and state plans provide this coverage. Lymphedema treatment mandates have been in effect in North Carolina since 2010 and in Virginia since 2004, and several other states have similar legislation pending. 3. Medicare’s failure to cover compression treatment supplies stems from the fact that these items cannot be classified under any existing benefit category in Medicare statute (law). The Center for Medicare Services (CMS) does not have the authority to add or redefine benefit categories, only Congress does, hence the need for this legislation. This is explained in more detail in a written exchange between our bill sponsor, Congressman Reichert, and former Health and Human Services Secretary, Kathleen Sebelius. 4. Medicare does not cover compression for lymphedema. Private payors however are mandated by law to cover lymphedema. Leg compression is for a limited number of diagnoses; diabetic or wound care is the diagnosis within a CPO’s scope of practice. 5. This is all Medicare covers when it comes to compression garments LCD for Surgical Dressings-Benefit Categoy Reminder explains compression stockings, this is the link: http://www.ngsmedicare.com/ngs/portal/ngsmedicare/surgical%20dressings%20-%20benefit%20category%20reminder_policy%20education/!ut/p/a1/vVTBcpswEP0VLj4yEhiMOLox9tgpcQNNHbh4ZGkhShEQkN2mX19hO42nE5u0nSknrXha7b59TyhF9ygt6U7kVImqpEUXp6M1XsRX46nrYBz6GM_Ho3g6m-Gh49sakJwHLG_si-evHbRCKUpZqWr1gJIybyVwwWgDrCoVlGqAT_YGGPiW7UszaMkN1VBRijIfYFboBaOF8QswwO22yfd7vIG21bDWMI0NlJAJZWgQ5FXzbDQgRcmhWddVIdjza4KurprmwKEV-SFigqPEA8wo84lJbGybDs98k7KhY9rUsi3fI9hz7H1PBdCGVdVXAV3Y0h28RlEwmy9vutXH5QeUTLYN3RRghPtGCyN42opa6vZf6D3zjfGB3pvh5EBv7Lp4HuDIC2PPxo7VNx73nefPA3rGe_H-DtAjr708egR2AFyg6GKTS7cHQIZ9Nbgo0W16ZzNc2yh-FRAQbo8wwQ63HB8sRtyhRz3PJxsYuW6WocU7hmI34VWYdwpVD6YoswrdF7aHbdL9FI9PT-lYS7Dz0Hctol5fsWoHjRa7wUFBox1x9JA8CvJoDqZPQjPAx6sWfcy_XSiXYMiaaTdSpsQOXth7oXfmf5zi-W3ozALiWzjAB_aErHURQoUVhwIlqtnurdTl0G5NOGR0W6gvAr79nnA5m070vKzPZHkd3o5C55BwdRWub–CSKNP3KmjU-vq8GhWveox65-9EYt3PK1vsPevz9pf6eN_vrurPjWkGK2OU49PFdB2U3tAtbyT5BGiYONGUZTFc_FJynWo3I1b7KQkQ7fOx5MfmVwRZa4W-U_WeUo4/dl5/d5/L3dHQSEvUUtRZy9nQSEh/?clearcookie=&savecookie=&REGION=&LOB=Durable%20Medical%20Equipment This is the LCD for Surgical Dressings (L27222): http://www.ngsmedicare.com/ngs/portal/ngsmedicare/l27222/!ut/p/a1/tVTBcpswEP0VevCRkRBg4Egd7HES7MZumsAlI4uFKAVBZNmJ-_UV2HEzncS0zZTTLnqrffP2rVCKblEq6JYXVPFa0LLN0-Edntln4dh1MF66Lp5GeOHFS49gx9KApAWcL0d7QBxgPA2Hy_Fkgu35jOzr3z52AoJuUIpSJlSj7lEiinUFGWdUAquFAqEG-NW_AWb1FiQtwMhAgay46HgO8B5RGk1dcrYzmK4EOcAl8QghbYdGF2Ww5oXoMsYzlOSWRRjzsZNhOrSJGwQOCXLmWZa3smzsdsxKoJLV9XcObbqmW_iVLaLJdD5ro8v5Z5ScbSRdlWDEBzLR44Y3labyItI7X4hPinTh9Ins9ol8sr5t8KH6If5YfUD6TNaZpMdme8AJiU82mbs9AN_u4-CeBrQyJVoH790WFwQt_8Kd53-wmkTGo7ho7a_uTS7yGt0edkIf8ofHxzTUHm9X7Vm79D-t33nfaN4mmlVgVA0zTIMyxbfwot6LvJPgcoynV7EzifzAwhHeq8erRpPgKq4zKFGi5Kbb1faOWqAkg5xuSvWNw9PvF84n4zM9L-urP7-Ir4axs7_wZhTfXV1HC41-tf46e_026PTwGuio5zU4jtgDzCgLfNMnmJhOlgcmZbZjEmoRK_B87DlH9U4u1xvqrTey6PpmEtZrrseohVyBgJwrg1EFRS13hgQ9xAzk3WFykG1YN9N_88ex3KAiM5SkXOjO2jelDloyR8AAf5RgU11X_gMsopW70F–nPKpSVf-zi631Y2OfuRVFYZfZma62j2Fn34CwAYNkA!!/dl5/d5/L2dBISEvZ0FBIS9nQSEh/ This is the artical (A47232) that goes with the LCD: http://www.ngsmedicare.com/ngs/portal/ngsmedicare/a47232/!ut/p/a1/tVRNc9owEP0r7oGjx_IXto4uMQxJDA00TewLI6S1o9SWHSFI6a-vDIRmOgSnzVSnXfut9s17u7Iy697KBNnwgiheC1K2edZfoIl7EQ19D6G576NxjGZBMg8c5NkakLaAy_lgD0gwQuOoPx-ORsidTpyu-jsrszIqVKMerFQUqwoYp0QCrYUCoXro1bceovUGJCnAYKBAVlzsePbQHlEaTV1yujWorgTZQ8QLHNdpOzS6iMGKF2KXUc6s1O7n2CUh8hgifcwcjH2CcxrYdrC0XeTvmJVAJK3r7xzadEU28DubxaPxdNJG19PPVnqxlmRZgpEcyMRPa95UmsqLSG-cCO1FOq2hd-V1iex_yKS2wbn-2Omo76OP1eP3DUnHmO0BZyQ-22TqdwBCt4uDfx7QypRqHYI3W1w51vwvpvPyHa47MhkkRTv-6sHkIq-t-8NO6J_88ekpi_SMt6v2Q0_pf1q_yy5rThNlFRhVQw3TIFTxDbyo9yLvCF8P0fgm8UZxiG0Uo716vGo0Ca6SmkFppUqud7va3lELK2WQk3WpvnF4_vPC6Wh4of2yv4bTq-Smn3j7C-8GyeLmNp5p9Kv119nrt0Gnh9dARx2vwdHiABAlFIdm6CDH9FiOTUJdz3SI7dg4CFHgHdU7u1wn1FutZbHryySsVlzbqIVcgoCcK4MSBUUtt4YEbSIDuTg4B2xNd57-23wcyw0imKEk4UJ31nNT6qAlcwT00EcJNtVtFT7CLF76M33y-ZiPTbIMt265qe509DOvqij6MjGz5fY5-vQLkVC_zA!!/dl5/d5/L2dBISEvZ0FBIS9nQSEh/ This is the Level II HCPCS Codes and HCPCS Modifiers which has a chart of of non-covered code and explaination: http://www.ngsmedicare.com/ngs/portal/ngsmedicare/chapter%2014/!ut/p/a1/nVTRlpowEP0VXnzckwhE8NEqenQX7cJRF148MQyYLQHEaLv9-gZ0W7ZdxVOeMuRmMrlz76AQvaAwoyeeUMnzjKZVHPY2eOYPB2Ni4omBdTwdLJfOaqHjycpUgKAJwG4fK0DPH08m2FjM9Y_nP26bjyZaoxCFLJOF3KEgSw4CIs5oCSzPJGSygxv_Org4blO1rIo7dLCg2ZGmasF2tJBQal2zylbQBCI48CSrI8YjFAAwbMc2Nk1ja-lWTI2uCRaYPQCL9WKoq0iBlizPv_E6PNAT_Ik8ZzJdzKvV0-ILCkbHkm5T0Ny6tFRz9kdeCFXwOyFXvgE-EzI3RmdCfELw1MGe5fqWjs1uG6HkzvPXAS0NuXl_BWgRRN3QFkmcATcouvnIBWkB2EZbDQQF6pnW1QyPOvIb4rEjvYeVeKKu2Ycus4lhUcvq21voERLHaHZHU_TSHbpJpU65e-BZnKOXVLewbleb_HW_DwdKgpXqfygRtTqB5ScoldC1CJTyBc9qUyhPXARZ5MoobxpTJ6Hs4MtVszbmPy80EqCJgmkPGmWSn-Cdvd8q6D-N8fTZNSeO3e9iB5_Z46JQRXDp5hGkKJDlsbZSlSPPUBBBTI-pXHH4_k_Cv2RFzgnXQ3fzvHQ8hW64U0VN66rwYla1ajHr_fNhdscg_IS5xmT6rza3D7x1WytCjNYXyv0m_YeKsh0qxFLYr-A5W-J5XuxP-VchNq4kW5KehLANUiSD0c9YrG35sJ4lvwAnPUrx/dl5/d5/L3dHQSEvUUtRZy9nQSEh/?clearcookie=&savecookie=&REGION=&LOB=Durable%20Medical%20Equipment 6. Medicare does not cover compression garments no matter what diagnosis is given. I have experienced some cases in which we could get Medicare to cover the compression garment however you have to have extremely good physician documentation for the patient’s need. These cases required we file appeals. Some insurance carriers will cover them however you should contact the insurance carrier first. 7. Medicare does not pay for elastic items except 40mmhg ulcer care hose when the patient is actively getting derided for a wound. There are very strick guidelines on this as well. I wish they would pay for lymphedema hose but the do not. Some insurances do but it depends in the policy and diagnosis. 8. I am an insurance biller & I would recommend referencing the Policy Article A24114, which can be found at the following link: http://www.cms.gov/medicare-coverage-database On the right hand side of the page, under Document ID, enter A24114. This should give you all of the information you need regarding coverage of compression garments. We have seen compression garments covered by Anthem BC/BS and other commercial insurance companies. 9. I am a certified orthotics and compression garment fitter in Idaho. Medicare does not consider coverage for compression stockings unless the following three criteria are met: Prescription required with the diagnosis code listed below (must also meet all the requirements for a Rx) Must be knee high only, 30-40 mmHg or greater pressure (A6531) Diagnosis code: 707.10 open venous ulcers If all three of these are not met then they will not be considered for coverage. When billing and the patient meets this criteria you must use the LTRT AW modifiers. The only reason it is considered for coverage is with this diagnosis L code then the garment is no longer considered a compression garment but a wound dressing. 10. Medicare does not cover any compression garments for lymphedema. Research the lymphedema treatment act that is in congress now. WWW.lymphedematreatmentact.gov
Source: oandp.com

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