Are Medicare rules changing for pneumatic compression devices?
“The Medicare rules are about to change substantially regarding coverage for pneumatic compression devices for US citizens with lymphedema and chronic venous insufficiency. This is very troubling news.” Thus began our discussion with Jonathan Ross, President of Bio Compression Systems, Inc., a U.S. manufacturer of pneumatic compression devices. Mr.
Are pneumatic compression devices (PCDs) covered by Social Security?
Pneumatic Compression Devices (PCDs) are covered under the Durable Medical Equipment benefit (Social Security Act §1861 (s) (6)). In order for a beneficiary’s equipment to be eligible for reimbursement, the reasonable and necessary (R&N) requirements set out in the related Local Coverage Determination must be met.
Does Medicare cover compression devices for lymphedema?
“The Medicare rules are about to change substantially regarding coverage for pneumatic compression devices for US citizens with lymphedema and chronic venous insufficiency.
What are the new local coverage determinations for pneumatic compressors?
New Local Coverage Determinations (LCDs) are being put in place for all four Medicare regions that will overwrite the National Coverage Determinations (NCDs) that are currently in place for pneumatic compression devices. While a LCD should never restrict a NCD, the new policy does just that.
What are the requirements for Medicare?
For any item to be covered by Medicare, it must 1) be eligible for a defined Medicare benefit category, 2) be reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member, and 3) meet all other applicable Medicare statutory and regulatory requirements.
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How many local coverage determinations are there in DME?
Now that the immediate threat is over, we should not wait for the next shoe to drop. There are four Local Coverage Determinations (LCDs) in effect in the four DME Regions. There is a process whereby changes to LCDs can be proposed to the Medical Directors and the Coverage Advisory Committees for each region. Are we preparing proposals to change these LCDs in a way that makes medical sense for lymphedema patients? Who is leading the effort?
Does Medicare cover massage therapists?
I am an MLD therapist. However, I am a massage therapist, certified in MLD. This means that Medicare won't cover me (to my knowledge). So, this new rule may be very challenging for clients having to find therapists, that are covered by Medicare. Unless they are in a more populated area, or near a cancer facility that has nurses/PTs/OTs on staff which are certified, it can become a very costly venture to have to pay for all of those sessions out of pocket.
Does Medicare have a local coverage determination?
New Local Coverage Determinations (LCDs) are being put in place for all four Medicare regions that will overwrite the National Coverage Determinations (NCDs) that are currently in place for pneumatic compression devices. While a LCD should never restrict a NCD, the new policy does just that. Below are some highlights of the changes that are scheduled to go into effect on November 1, 2014:
What is pneumatic compression?
Pneumatic compression devices consist of an inflatable garment for the arm or leg and an electrical pneumatic pump that fills the garment with compressed air. The garment is intermittently inflated and deflated with cycle times and pressures that vary between devices.
What is the least costly alternative for a DME?
06/1995 - Clarified that nonsegmented and segmented pump without manual control of pressure in each chamber is considered the least costly alternative that meets the clinical needs of the individual for this type of DME, unless there is documentation that warrants payment of the more costly manual control pump. Effective date NA. (TN 77)
What is a national coverage determination?
National Coverage Determinations (NCDs) are national policy granting, limiting or excluding Medicare coverage for a specific medical item or service.
Is pneumatic compression a conservative treatment?
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.
What is pneumatic leg compression?
A pneumatic leg compression device is a garment with an electrical pump that fills the device with compressed air.
Does Medicare cover out of pocket costs?
Even if Medicare covers some of your costs, you will likely be responsible for paying out-of-pocket costs like deductibles, copayments and coinsurance.
Does Medicare cover gauze?
Walkers. Medicare Part B typically does not, however , cover common medical supplies such as bandages, gauze and compression stockings. If a you are affected by serious complications associated with the cause of your leg pain or from surgery, then your care, doctor's visits and other forms of alleviation may be included in Medicare coverage.
Is a pneumatic compression device covered by Medicare?
According to the Center for Medicare and Medicaid Services, "Pneumatic compression devices are covered only when prescribed by a physician and when they are used with appropriate physician oversight, i.e., physician evaluation of the patient's condition to determine medical necessity of the device, assuring suitable instruction in the operation of the machine, a treatment plan defining the pressure to be used and the frequency and duration of use, and ongoing monitoring of use and response to treatment.1"
Does Medicare cover compression stockings?
Medicare does not typically cover compression stockings. However, Medicare does provide coverage for pneumatic compression devices in certain situations. While compression stockings can be prescribed by a general practitioner to help to maintain the blood flow and reduce discomfort and swelling in the lower legs, ...
What is a pneumatic compression device?
A Pneumatic Compression Device (PCD) is durable medical equipment. A PCD is an electric or battery powered pump with attached inflatable appliances (sleeves) that fills with compressed air. As the appliance inflates, it applies compressive pressure gradient against the limb.
What is DME equipment?
Durable Medical Equipment (DME): DME is equipment that: Can withstand repeated use; Is primarily and customarily used to serve a medical purpose; Generally, is not useful to a person in the absence of an illness or injury; and. Is appropriate for use in the home.
Can PCD devices be reimbursed?
PCD devices which include cold therapy are not eligible for reimbursement. When a PCD is determined to be ineligible for reimbursement, all related appliances and accessories are also ineligible for reimbursement.
Is PCD reimbursement included in ASC fee?
NOTE: Use of a PCD in a facility (i.e., Ambulatory Surgery Center (ASC) is not eligible for reimbursement as it is included in the facility fee for the procedure (s); as such not separately allowable billed by the facility or a DME supplier.
What are compression socks?
Compression socks used for medical reasons have different pressure levels that are measured by mm/Hg. Lower compression stockings feel snug and are great for you while you’re up and about on your feet. Higher compression stockings are firmer and are for DVT patients.
Do compression socks help with swelling?
Graduated compression socks can place pressure on the foot while it puts less stress on the legs. Relieving pressure on the foot helps to maintain circulation to the feet, which can cause swelling. While compression socks can be super beneficial, they don’t have coverage, even with a prescription.
Will Medicare Cover Pneumatic Compression Devices?
While Medicare usually doesn’t cover compression socks, they do cover pneumatic compression devices. Although socks help with ailments, the socks aren’t enough to constitute coverage.
Do you need a prescription for socks?
However, it’s best to check with Medicare before purchasing to determine if an order is necessary for the specific socks you’re needing. Socks with a higher compression typically may need a prescription if obtaining from a pharmacy.
Do compression socks work for DVT?
You can obtain a prescription from your doctor, but you’ll have to pay out of pocket for the socks. Medicare doesn’t provide coverage for compression socks that treat varicose veins, circulation issues or prevent ulcers.
Does Medicare Cover Lymphedema Compression Stockings?
Compression socks can improve the draining of the lymph in ankles and feet, vastly improving the condition of Lymphedema. Medicare doesn’t extend coverage to compression for lymphedema. However, those with an HMO or PPO Medicare Advantage plan may have access to additional coverage that includes over-the-counter benefits.
Why do compression socks work?
Although they may look like a normal sock at first glance, compression stockings serve a highly specialized purpose in health care. Because they surround the leg with constant pressure, they help keep blood flowing and can prevent clots from forming and help to decrease risks related to poor circulation in the lower limbs.
Why do people wear compression stockings?
There can be multiple reasons to use compression stockings, but the most common include treating circulation issues that arise from diabetes or occur after surgery . They also benefit anyone who spends a majority of their time in bed or who may not be able to move their legs much.
Is compression stockings considered durable medical equipment?
Because compression stockings may be medically necessary in some cases, they would meet part of the qualifications required for durable medical equipment status. Unfortunately, most standard compression stockings do not meet other requirements in order to qualify for coverage under this definition.
Do you have to wear compression stockings for Medicare?
If you’ve been told that you need to wear compression stockings, it’s important to understand how they work and the variety of uses they have for treating different medical conditions . In certain circumstances, Medicare recipients may have the cost of these stockings covered by their benefits.
Do you need to verify Medicare Advantage?
Because these extras can be different depending on which private insurer is contracted to provide the Medicare Advantage plan or Medicaid benefits, you will need to verify these coverage options with a representative for that insurer.
Does Medicare Advantage cover compression stockings?
Some Medicare Advantage plans may offer extra benefits that include an allowance for over-the-counter medical supplies. Dual-eligibles who also receive Medicaid assistance may have prescription compression stockings covered under their regular benefits or by a provider’s allowance for over-the-counter items.
