Medicare Therapy Coverage For Lymphedema

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Getting Medicare to recognize lymphedema therapy as essential medical expenditure has been a difficult task. Lymphedema patients have been long trying to get the benefit of Medicare for the expenses that they incur for the therapy that continues throughout their life. The Women’s Health and Cancer Rights Act states that complications arising due to breast cancer surgery, which includes lymphedema, must be covered by all insurance providers. However, this coverage does not extend to those who suffer from primary or secondary lymphedema. In February 2008, the compression garments considered an essential part of lymphedema therapy were classified as covered items for Medicare.

Lymphedema is a condition that has no medical cure, although it can be managed with therapy which is known as the Complete Decongestive Therapy or CDT. The process involves a lymphatic massage combined with the use of compression bandages and compression garments, a skin care routine and a regular exercise regimen. The most important aspect of the therapy is the manual lymph drainage (MLD) which aims at draining the stagnated lymph to reduce the swelling. Occasionally, the therapist might use the Sequential Gradient Pump to loosen fibrotic tissues before the massage. The therapist performing the lymphatic massage is a specialized professional trained in the technique. Therapy sessions in the early stages may be held frequently, at least five days a week. Those who do not have easy access to the lymphedema therapist may use a sequential gradient pump for the lymphatic drainage process.

Medicare covers the lymphedema pump therapy, but recently the coverage rules have been modified. Previously, although the pneumatic compression devices were included in coverage, the patient had to attempt all other methods of treatment first, a process that took many months. This has changed now. Compression devices have been included under durable medical expenses for both primary and secondary lymphedema. There is a four-week trial period which the doctor must observe. A course of medication, use of compression garments and elevation of the limb is followed by the patient and if no improvement is seen, the doctor prescribes a pneumatic pump. The doctor is required to give a Certificate of Medical Necessity to enable the patient to procure a lymphedema pump from a Medicare authorized supplier. The supplier of the pump must be enrolled with Medicare and possess the Medicare Supplier Number, or you will not be reimbursed the claim.

In case of compression garments, which can be a large recurring expense, lymphedema sufferers have had to deal with legislatures which prevented their inclusion in Medicare coverage lists. A positive judgment in February 2008 has come to the aid of lymphedema patients. Compression garments were classified as items meeting the standards for covered items. Items like compression bandages, compression sleeves and stockings were considered medically essential and would be covered as prosthetic devices under Medicare for lymphedema therapy. The lymphedema patients can take advantage of this edict and claim a compensation for these medically essential items that help them to manage the lymphedema.

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