There are many different ways to submit for payment of compression garments.  These can be covered for venous leg ulcers, lymphedema, trauma indications, and more.  There are extensive coverage guidelines and coding considerations for each of many different indications.  These guidelines are not established by states.  Instead, they are established by third party payers.  Different payers can have different coverage guidelines and there are dozens of third party payers in New York State.   This results in many different guidelines, which can differ based on product, indication, payer, and more.  Thoroughly listing all of these is not appropriate for this forum.  Some pearls and key points are listed here.  (This is not all all-inclusive list of all compression guidelines.)

 

One of the more common indications for dispensing compression garments is venous stasis ulcer.  When compression garments are dispensed for Part B Medicare beneficiaries under the DME benefit, coverage is dictated by the DMEMAC Surgical Dressings Local Coverage Determination and DMEMAC Surgical Dressings Policy Article.

LCD - https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?LCDId=33831&ContrID=140

Policy Article - https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=54563

 

As of January 1, 2024, ready-to-wear, non-elastic, gradient compression wraps with adjustable straps are be covered for Part B Medicare beneficiaries for the treatment of lymphedema, even in the absence of an open ulcer.  When being used to treat lymphedema, three daytime garments or wraps with adjustable straps for each affected limb or area of the body are allowed, with replacement every 6 months allowed when medically necessary.  Payment for compression bandaging systems under this benefit category includes Phase 1 (acute or decongestive therapy) and Phase 2 (maintenance therapy) lymphedema treatments.  More information on this was provided for NYSPMA and APMA members here:  https://www.apma.org/practice-management/reimbursement-resources/dme-physician-supplier/lymphedema-compression-policy-changes-for-2024/