Getting Medicare to recognize lymphedema therapy as an essential medical expense has been a difficult task. Lymphedema patients have long sought the benefit of Medicare for the costs they incur for therapy that continues throughout their lives. The Women’s Cancer and Health Bill of Rights states that all insurance companies must cover complications from breast cancer surgery, including lymphedema. 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 controlled with therapy known as Complete Decongestive Therapy or CDT. The process involves lymphatic massage combined with the use of compression wraps and compression garments, a skin care routine, and a regular exercise regimen. The most important aspect of the 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 fibrotic tissues prior to 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 pump therapy for lymphedema, but the coverage rules recently 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 observe. The patient follows a course of medication, use of compression garments and elevation of the extremity and, if no improvement is observed, the doctor prescribes a pneumatic pump. The physician is required to provide a Certificate of Medical Necessity to allow the patient to purchase a lymphedema pump from a Medicare-authorized provider. The supplier of the pump must be enrolled in Medicare and have the Medicare supplier number, or your claim will not be reimbursed.
In the case of compression garments, which can be a large recurring expense, people with lymphedema have had to deal with legislatures that prevented their inclusion on Medicare coverage lists. A positive trial in February 2008 has come to the aid of lymphedema patients. Compression garments were classified as meeting the standards for covered articles. Items such as compression bandages, compression sleeves, and stockings were considered medically essential and would be covered as prosthetic devices by Medicare for the treatment of lymphedema. Lymphedema patients can take advantage of this edict and claim compensation for these medically essential items that help them manage their lymphedema.