Published on: December 14, 2020
Medicare Policy for Compression Garments
Hard to believe but Medicare does NOT cover most compression garments. Medicare may cover cancer surgery, therapy for lymphedema, and other swelling disorders but when it comes to Medicare covering compression garments, 99% of Medicare recipients will have to pay out of their own pocket.
Medicare does cover some compression garments for the lower extremity when the Medicare recipient is diagnosed with Chronic Venous Insufficiency and Venous Stasis Ulceration(s) ICD-10: I87.319. When Medicare does cover garments for this diagnosis, the selection is minimal.
Medicare will provide coverage only to the limb with the Venous Stasis Ulceration and will provide only one garment. Medicare coverage is limited to either 30-40mmHg Ready to Wear Circular Knit Compression Stockings, Knee High only (HCPCS: A6531), and Gradient Compression Wrap, Non-Elastic, Below Knee, 30-50mmHg Velcro Compression Binders (HCPCS A6545).
HCPCS: Healthcare Common Procedure Coding System
The Healthcare Common Procedure Coding System (HCPCS, often pronounced by its acronym as “hick picks”) is a set of health care procedure codes based on the American Medical Association’s Current Procedural Terminology (CPT).
ICD-10 code: International Statistical Classification of Disease
ICD–10 ICD–10 is the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD), a medical classification list by the World Health Organization (WHO). It contains codes for diseases, signs, and symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or diseases.
Garments covered by Medicare with a diagnosis of Chronic Venous Insufficiency with a Venous Stasis Ulceration.
- Compression Stocking, Below Knee, 30-40mmHg
- Pic of any knee-high stocking
- Gradient Compression Wrap, Non-Elastic, Below Knee, 30-50mmHg
- CompreFlex Transition (pic and description)
- Juxta Lite HD (pic and description)
- Juzo Wrap (pic and Description)
- ReadyWrap (pic and Description)
- Farrow Basic (pic and Description)
Medicare Does Not Cover:
- Compression Garments for Lymphedema
- Compression Garments for Lymphedema for prevention following cancer surgery
- Compression Garments for DVT’s
- Compression Garments for Diabetes
If you would like to help make a change to Medicare’s compression garment policy please consider writing to your local representatives. Click on the link below for more information on how you can help patients with lymphedema receive much-needed coverage Lymphedema. Click here for more information on the Lymphedema Treatment Act
Without properly fitting compression garments patients with lymphedema continue to swell, are at risk for infections and hospitalization which will cost Medicare millions of dollars each year. Lymphedema patients must have correctly fitting compression garments at all times to independently manage their swelling. Without it, they will continue to have increased swelling which only leads to an increase in therapy and hospitalization costs.