Answers to compression garments
Description
Collection
Title:
Answers to compression garments
Date:
9/10/2014
Text:
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:
<URL Redacted>
This is the LCD for Surgical Dressings (L27222):
<URL Redacted>
This is the artical (A47232) that goes with the LCD:
<URL Redacted>
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=®ION=&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 < http://www.lymphedematreatmentact.gov/ > we
need to write our representatives to get this bill passed so that there
will be coverage for lymphedema products.
More and more of the third party insurance companies are denying coverage
for compression garments as well.
11. Collect private pay for garments. Be sure to charge a measuring fee on
top
of the garment charge. Make it a rule NOT TO TAKE INSURANCE FOR ANY
GARMENTS.
Courtesy bill for the patient, or give a billing to the patient to file to
their insurance
company if your allowed.
A ABN claim OnAssignment billing for Medicare requires you bill Medicare
for the patient.
12. If Medicare is primary and the patient has a true secondary and not a
medicare supplemental plan then there is a possibility it might have some
coverage but you should probably get an ABN to be safe. About the only way
to check coverage is to submit for preauth on the secondary plans or at
least call with l code and dx code and check directly.
Medicare covers c-garment ONLY under venous stasis ulcer Dx and ONLY in
30-40 c-ratio.
Melanie Antweiler, CP, COF, Operations Manager
Smoky Mountain Limb & Brace
256 Marsh Lily Dr.
Sylva, NC 28779
Phone: 828-631-5280
Cell: 828-400-3946
Fax: 828-586-2774
www.smlb.net
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:
<URL Redacted>
This is the LCD for Surgical Dressings (L27222):
<URL Redacted>
This is the artical (A47232) that goes with the LCD:
<URL Redacted>
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=®ION=&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 < http://www.lymphedematreatmentact.gov/ > we
need to write our representatives to get this bill passed so that there
will be coverage for lymphedema products.
More and more of the third party insurance companies are denying coverage
for compression garments as well.
11. Collect private pay for garments. Be sure to charge a measuring fee on
top
of the garment charge. Make it a rule NOT TO TAKE INSURANCE FOR ANY
GARMENTS.
Courtesy bill for the patient, or give a billing to the patient to file to
their insurance
company if your allowed.
A ABN claim OnAssignment billing for Medicare requires you bill Medicare
for the patient.
12. If Medicare is primary and the patient has a true secondary and not a
medicare supplemental plan then there is a possibility it might have some
coverage but you should probably get an ABN to be safe. About the only way
to check coverage is to submit for preauth on the secondary plans or at
least call with l code and dx code and check directly.
Medicare covers c-garment ONLY under venous stasis ulcer Dx and ONLY in
30-40 c-ratio.
Melanie Antweiler, CP, COF, Operations Manager
Smoky Mountain Limb & Brace
256 Marsh Lily Dr.
Sylva, NC 28779
Phone: 828-631-5280
Cell: 828-400-3946
Fax: 828-586-2774
www.smlb.net
Citation
“Answers to compression garments,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 1, 2024, https://library.drfop.org/items/show/236723.
