Original Medicare (Parts A & B): Lymphedema Compression Treatment Items

For those diagnosed with lymphedema, prescribed gradient compression garments are covered.

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Cost
20% of the Medicare-approved amount; Part B deductible applies
Prior Authorization Required
No
Provider Referral or Order Required
Yes

How To Receive

Details on how to apply

  1. Obtain a provider order for the necessary gradient compression garment.

    • The order should include the body part(s) requiring compression, the type of garment(s) needed, and the size of the garment(s).

    • The size may be changed by the qualified professional conducting the garment fitting.

  2. Take the order to a qualified gradient compression garments supplier who can bill Medicare for fulfillment. Availability and cost coverage may depend on the specific type of garment needed and the intended purpose.

    • Healthcare providers

    • Medical supply store

    • Pharmacies

    • Online retailers

    • Specialty clothing stores

    • Medical equipment rental services

  3. Notify the ordering provider if the qualified professional who conducted the garment fitting changed the original size ordered.

Availability
As ordered by a provider
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If you or your loved one has been diagnosed with lymphedema, prescribed gradient compression garments (standard and custom fitted) are covered.

It's essential to consult with a healthcare professional to determine the appropriate level of compression and the specific type of garment needed. Proper sizing and fit are crucial for the effectiveness of gradient compression garments, so it's advisable to seek guidance from healthcare providers or trained professionals when making a selection.

Lymphedema

Lymphedema is a chronic medical condition characterized by the accumulation of excess lymphatic fluid, leading to swelling in certain parts of the body. This condition usually occurs when the lymphatic system, which is responsible for draining fluid and waste products from tissues, is compromised or damaged. Common causes include surgery, radiation therapy, infection, or congenital conditions that affect the lymphatic vessels.

The most common symptom of lymphedema is swelling, which can range from mild to severe and may be accompanied by a feeling of heaviness or tightness in the affected limb or body part. Other symptoms may include aching or discomfort, decreased flexibility, and an increased risk of infections.

Management typically involves a combination of therapies, such as manual lymphatic drainage, compression therapy, exercise, and skincare. While there is no cure for lymphedema, early diagnosis and appropriate treatment can help manage symptoms and improve the quality of life for individuals affected by this condition.

Gradient compression garments

Gradient compression garments are specialized clothing designed to apply varying levels of pressure to different parts of the body. The key feature of these garments is that the pressure is highest at the extremities and gradually decreases towards the core of the body. This gradient compression helps facilitate the flow of blood and lymphatic fluid, aiding in circulation.

These garments are often used in medical and therapeutic contexts to prevent or alleviate various circulatory issues, including lymphedema, where they are used to promote the drainage of excess lymphatic fluid. They come in various forms, including stockings, sleeves, gloves, and full-body suits.

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