Q. I was diagnosed with lymphedema of my left arm following breast surgery. I had therapy for 5 weeks with minimal response and was recommended to wear a 20-30mmHg arm compression sleeve every day. Most of the medical supply retail stores in my area inform me that Medicare does not cover compression garments. [Deleted] which has a contract with Medicare informs me that Medicare only covers garments with 40-50mmHg level of Compression. Kaiser Permanente Senior Advantage covers 20-30mmHg compression garments. How come Medicare does not? If I pay cash for these garments, will Medicare reimburse me? How should I go about this?

A. Kaiser covers lymphedema compression bandages and garments because Medicare Advantage Organizations (MAOs/HMOs) can cover whatever they wish, so long as they cover as minimum what Medicare covers. In 2000 I won a case against Kaiser and they started to cover these items for lymphedema as well as burns and venous ulcers. Since January 1, 2014 the state of California insurance Marketplace covers them also. More details can be found at
http://www.lymphactivist.org/ca_garment_coverage.php

Medicare does cover compression stockings at 30-40mmHg compression, but only for treatment of venous ulcers, not for unbroken skin. The only way you can be reimbursed for your expenses is to purchase them from a Medicare-enrolled supplier with a referral (prescription) from a Medicare-enrolled physician. The supplier must file a claim, and when it is denied you file an appeal. You might start by reading my appeal philosophy at
http://www.lymphactivist.org/philosophy.php

You may learn how to appeal a denial at
http://www.lymphactivist.org/approach_to_medicare_appeal.php

Back to top
Lymphedema Treatment is Good Business as well as Good Medicine
© 2002 Robert Weiss, Porter Ranch, CA