Medicare Therapy for lymphedema
Medicare therapy cover.
Until recently, Medicare did not cover all the costs involved in lymphedema therapy. It has been an uphill task for lymphedema patients trying to get the benefits of Medicare. Women’s Health and Cancer Rights Act directs that insurance companies must provide coverage for the complications resulting from breast cancer surgery, including lymphedema. But other types of secondary lymphedema and primary lymphedema have not been accorded the same status of a complete coverage. However, in February 2008, compression garments used in the therapy to treat lymphedema were defined as covered items.
Lymphedema is an ailment that has no surgical or medical cure, but can only be managed with the help of Complete Decongestive Therapy (CDT). The therapy consists of manual lymph drainage, compression bandages, compression garments, exercises and some skin care routine so as to manage the debilitating condition of lymphedema. The mainstay of lymphedema treatment is manual lymphatic drainage that helps to drain the fluids and reduce the swelling. The lymph drainage is carried out through manual lymph drainage (MLD) therapy or sometimes the sequential gradient pump is used. A therapist specifically trained to perform the massage will conduct MLD on the affected limb of the patient. These therapy sessions may be held at least five times a week in the initial stages of therapy. People who have no access to a therapist can make use of the Sequential Gradient Pump for lymphedema treatment.
Medicare coverage for lymphedema pump therapy has been modified recently. Earlier on, although pneumatic compression pumps were covered, the patient had to try all other treatments first. This process took more than a few months. However, this policy has now been modified and lymphedema patients can use it to their advantage. Compression pumps are covered as a treatment device under durable medical equipment for primary as well as secondary lymphedema. But the doctor must monitor the patient for a 4 week trial period of medication, compression garment therapy and limb elevation. If there is no improvement, then a pump can be considered with the doctor’s prescription. The doctor will provide a Certificate of Medical Necessity so that the patient can procure the pump from a supplier enrolled with Medicare. Medicare will not pay for the claim if the compression pump is procured from a supplier who does not have the Medicare supplier number.
With the issue of compression garments however, lymphedema patients have had to contend with legislatures that prevented them from being included in the Medicare coverage lists. However, due to a positive ruling in February 2008, compression garments were defined as meeting the standards of covered items. Compression bandages, stockings and sleeves were deemed medically essential and could be covered under Medicare for lymphedema therapy, as prosthetic devices. The good news is that patients can now obtain a reimbursement for these essential items of their lymphedema management therapy.
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