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Medicare Therapy Coverage for Lymphedema

Getting Medicare to recognize lymphedema therapy as an essential medical expense has been a difficult task. Lymphedema patients have long been trying to obtain Medicare benefits to cover the costs they incur for therapy that continues throughout their lives. The Women’s Cancer and Health Rights Act states that complications from breast cancer surgery, including lymphedema, must be covered by all insurance providers. However, this coverage does not extend to those with primary or secondary lymphedema. In February 2008, compression garments considered an essential part of lymphedema therapy were classified as Medicare-covered items.

Lymphedema is a condition that has no medical cure, although it can be treated with a therapy known as complete decongestant therapy, or CDT. The process involves a lymphatic massage combined with the use of compression bandages and garments, a skincare routine, and a regular exercise regimen. The most important aspect of therapy is manual lymphatic drainage (MLD) which aims to drain stagnant lymph to reduce swelling. From time to time, the therapist may use the sequential gradient pump to loosen the fibrotic tissues before the massage. The therapist who performs the lymphatic massage is a specialized professional trained in the technique. Therapy sessions in the early stages can be done frequently, at least five days a week. Those who do not have easy access to the lymphedema therapist can use a sequential gradient pump for the lymphatic drainage process.

Medicare covers lymphedema pump therapy, but coverage rules have recently been changed. Previously, although pneumatic compression devices were covered, the patient had to try all other treatment methods first, a process that took many months. This has changed now. Compression devices have been included in durable medical expenses for primary and secondary lymphedema. There is a four-week trial period that the doctor must adhere to. The patient follows a cycle of medication, the use of compression garments and elevation of the limb, and if no improvement is seen, the doctor prescribes a pneumatic pump. The physician must provide a Certificate of Medical Necessity for the patient to purchase a lymphedema pump from a Medicare-authorized supplier. The pump supplier must be enrolled in Medicare and possess the Medicare supplier number, or the claim will not be reimbursed.

In the case of compression garments, which can be a large recurring expense, those with lymphedema have had to contend with legislatures that prevented their inclusion on Medicare coverage lists. A positive trial in February 2008 has helped lymphedema patients. Compression garments were classified as items that met the standards for covered items. Items such as compression bandages, compression sleeves, and stockings were considered medically essential and would be covered as prosthetic devices under Medicare for lymphedema therapy. Lymphedema patients can take advantage of this edict and claim compensation for these medically essential items that help them control lymphedema.

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