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Medicare Coverage News
Medicare coverage of compression garments for Venous Ulcers

CMS has issued a Program memorandum to its Medicare carriers on June 20, 2003 announcing a change in policy concerning compression garments. Change Request #2739, Coverage of Compression Garments in the Treatment of Venous Stasis Ulcers is not directly applicable to lymphedema treatment, but has some interesting implications.

The new policy, effective for items provided on or after October 1, 2003, covers gradient compression stockings for treatment of open venous stasis ulcer that has been treated by a physician or other health care professional requiring medically necessary debridement, when the stocking can be proven to deliver compression greater than 30 mm hg and less than 50 mm hg. The stockings must serve a therapeutic or protective function and must be needed to secure a primary dressing. It is covered as a (secondary) surgical dressing (even though it has an orthotics HCPCS code).

This is somewhat of a breakthrough since compression stockings have been denied as coverable medical items even when used for wound care, burn care or lymphedema treatment. This is an interest development in view of the fact that a significant percent of lower limb lymphedema is combined with (and sometimes results from) a venous insufficiency.

Comments on the unfairness of denying medically required compression garments in the treatment of lymphedema according to current standards of treatment should be directed to your Congressional representative.

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