Faqs

Primarily custom-made, short-stretch compression garment with seams that can fit almost any shape. They are much easier to put on and take off, and provide better coverage and containment throughout the day, and are the preferred choice by medical professionals for the management of mild to severe lymphedema (stage 0 to 3) and chronic venous insufficiency. “Short-stretch” means the fabric means the fabric gives a low resting pressure and constriction, eliminating a tight pinch.

A ready-to-wear, seamless, long stretch compression garment intended for mild lymphedema, mild vascular conditions, post-operative swelling, DVT prevention, and chronic venous hypertension. “Long stretch” means the fabric gives a high resting pressure, adding a level of constant constriction through the coverage area, and may bind or pinch in the crevices of the body.

Circular knit garments tend to curl and pinch on a patient with lymphedema, causing pain, skin breakdown, and increased swelling. This occurs even though the patient measurements fit into a standard size. It is recommended by most medical professionals that patients with upper or lower extremity lymphedema be measured and fit by an experienced professional, and wear a custom-made flat knit compression garment.

At Lymphmed and LymphRx, we are committed to helping you navigate these processes and ensuring you receive the best possible care for your lymphedema.

Medicare Coverage for Lymphedema Garments
Starting January 1st, 2024, Medicare began to cover the use of graduated compression stockings, adjustable compression wraps, night time compression garments, and bandaging for patients diagnosed with lymphedema, as part of the implementation of the Lymphedema Treatment Act.

Compression garments are usually not covered by Medicare for most indications. However, there is an exception for patients with a diagnosis of an active venous stasis ulcer, provided there is specific documentation and a prescription for graduated compression stockings or adjustable compression wraps with compression levels of 30-40 mmHg or 40-50 mmHG.

Compression Products Coverage
To qualify, the compression stockings must be accepted by Medicare and given a PDAC letter of approval. Products must be billed through an approved DME (durable medical equipment) provider. In most cases, Medicare will cover 3 garments every 6 months. 

Compression Pumps Coverage
Approved Medicare pneumatic compression devices are a covered benefit with a diagnosis of lymphedema or chronic venous insufficiency with an open venous leg ulcer that has been treated for at least 6 months. Medicare requires a prescription as well as some specific clinical notations from a physician prior to authorization of the compression pump. Compression pumps must be billed and set up by an approved Medicare DME who can determine if a patient qualifies for insurance coverage. In some cases, the entire cost of the compression pump is not covered 100% and the patient may be responsible for a co-pay.

Determining Medicare Coverage for Medical Products
To find out if you qualify for compression garments via medicare, it's important to have a clear diagnosis with a prescription from your healthcare provider. Check your insurance plan benefits for DME coverage.  LymphRX can provide more detailed guidance based on your specific prescription. Fill out a patient form or call us for more detailed information. 

Documentation for Health Insurance Claim
In most cases, a DME (durable medical equipment) provider will need the following information to determine coverage or submit a claim:

• Beneficiary name/ policy #

• Prescription with diagnosis (ICD-10 code)/Certificate of Medical necessity

• Product Description / HCPCS product code

• Quantity/ Duration of use

• Refills