Medicare Benefits

Medicare currently has very specific requirements and criteria for coverage of compression products. Our billing experts will help you understand your Medicare benefits and provide an out-of-pocket estimate of the cost to you as part of the verification process.

Please contact us at 1-888-214-4100 with any questions about your Medicare insurance benefits, or email us directly.

FAQ's about Medicare Coverage

  • Ready-to-Wear Knee High Compression Stockings 30-40mmHg

  • Ready-to-Wear Knee High Compression Stockings 40-50mmHg

  • Non-Elastic Gradient Compression Wrap, 30-50mmHg

Compression stockings are only covered when the garments are used in the diagnosis of venous insufficiency and open venous stasis ulcer. 

A wound caused by, or TREATED by, a surgical procedure; or,


After debridement of the wound, regardless of the debridement technique


The surgical procedure or debridement must be performed by a TREATING PRACTITIONER or other HEALTHCARE PROFESSIONAL.


Debridement can be any type of debridement (examples given are not all-inclusive)

  • Surgical (e.g., sharp instrument or laser)
  • Mechanical (e.g., irrigation or wet-to-dry dressing
  • Chemical (e.g., topical application of enzymes) or
  • Autolytic (e.g., application of the occlusive dressing to an open wound)
  • Venous Insufficiency WITHOUT a stasis ulcer
  • Prevention of stasis ulcer
  • Prevention of the re-occurrence of stasis ulcers that have healed
  • Treatment of lymphedema in the absence of ulcer

 

In these situations, since there is no qualifying wound, the stockings/wraps do not meet the definition of a surgical dressing. Claims for these uses will be denied as NON-COVERED, with no benefit.

The recommended compression garments that are covered by Medicare are:

  • Sigvaris Compreflex Lite
  • Medi Circaid Juxtalite HD
  1. Patient Demographic Sheet
  2. Completed Absolute Medical Order Form
  3. Initial wound evaluation
  4. The most recent wound care note lists the following:
    • The type of wound (venous stasis ulcer)
    • Wound(s) location
    • Wound size (length, width) and depth
    • Amount of drainage, and
    • Any other relevant wound status information
  5. Once you submitted the above documents to AMI for review, we will send out a request for a written request from the patient’s ordering physician.