I am appealing to my insurance for compression garments (Medicare type HMO). Are there any studies that have been helpful to you that can help justify the need?

1. The most concise evidence documents I can think of are those of the International Lymphedema Framework. There is an upper extremity document and a lower extremity document. They can be downloaded from the web sites as follows:
   
   Upper Extremity: see the article starting at page 16:
   http://www.woundsinternational.com/pdf/content_8796.pdf
   
   Lower Extremity: see article starting at page 5:
   http://www.woundsinternational.com/pdf/content_177.pdf
2. You may find references to scores of studies showing the efficacy of CDT (including use of compression garments) on my web site at:
   http://www.lymphactivist.org/efficacy_of_cdt.php
3. Medicare recognizes the medical necessity of compression in that the preconditions for obtaining a pneumatic compression device is that conservative therapy be tried for a month. This is found in the NCD Manual CMS Pub. 100-03, §280.6:
   

   Pneumatic compression devices are covered in the home setting for the treatment of lymphedema if the patient has undergone a four-week trial of conservative therapy and the treating physician determines that there has been no significant improvement or if significant symptoms remain after the trial. The trial of conservative therapy must include use of an appropriate compression bandage system or compression garment, exercise, and elevation of the limb. The garment may be prefabricated or custom fabricated but must provide adequate graduated compression.

4. There are a number of consensus documents which all recognize the central role of compression garments in the treatment of lymphedema. Some of them are:
   1. National Lymphedema Network Position Paper on Diagnosis and Treatment of Lymphedema February 2011 http://lymphnet.org/pdfDocs/nlntreatment.pdf
   2. The Diagnosis and Treatment of Peripheral Lymphedema: 2013 Consensus Document of the International Society of Lymphology

      "A prescription for low stretch elastic garments (custom made with specific measurement if needed) to aintain lymphedema reduction after CPT is essential for long-term care."
      http://www.u.arizona.edu/~witte/2013consensus.pdf

   3. American Cancer Society Lymphedema Workshop. Workgroup III: Diagnosis and management of lymphedema. Rockson SG, Miller LT, Brennan MJ et al. Cancer 1998 Dec 15;83(12 Suppl American):2882-5.

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