Lymphedema Compression Bandages and Garments are Prosthetics

URGENT ADVOCATE ALERT: Trends in Risk Reduction Practices for the Prevention of Lymphedema * *
advocacy news, Medicare coverage of Lymphedema Garments, Bandages and Supplies, ssdi, new york lymphedema bill, medicare drug plan, medicare therapy caps, Access to Physical Medicine and Rehabilitation Services Act, medicare Outpatient Therapy Caps Exception Process 2007, Lymphedema Stakeholders, Prosthetics, Orthotics, long term disability, Georgia Medical, Nursing and Therapy Schools, Georgia lymphedema resolution, lymphatic disease awareness, insurance companies, resource links, Status of state bills for lymphedema treatment, Lymphedema Awareness Day - Georgia, Consumer Actions Websites, Health Policy Issues, How to lobby, National institutes health, Patient advocacy, Federal government, state government resources

Moderators: Birdwatcher, jenjay, Cassie, patoco, Senior Moderators

Lymphedema Compression Bandages and Garments are Prosthetics

Postby patoco » Tue Aug 22, 2006 5:00 am

Sent: Tuesday, August 22, 2006 4:25 AM
Subject: Compression Bandages and Garments are Prosthetics

As many of you know, I have been assisting Medicare beneficiaries in appeals of their denials of lymphedema treatment materials. My legal and medical arguments, supported by references to medical sources as well as relevant Medicare laws and policies, made the case that compression therapy materials (specifically: compression bandaging systems; compression garments; directional flow pads and garments; non-elastic compression devices) are reasonable and medically necessary in the treatment of lymphedema according to current medical standards. Furthermore, they meet all of the statutory requirements of prosthetics according to Section 1861(s)(8) of title XVIII of the SSA and should not be denied because “they do not fit any statutory benefit category”.

On August 16, 2006 a U.S. Administrative Law Judge in Southern California found that certain items received by a Medicare beneficiary for the treatment of lymphedema “were reasonable and necessary for reimbursement as a prosthetic device” and that “payment is to be made on the beneficiary's behalf for the reasonable and necessary medical services rendered and billed.” The items included compression bandaging materials, a directional flow sleeve, compression arm sleeve and gauntlets. Visits to a lymphedema treatment center for the purposes of evaluation and measurement and fitting of the sleeves and gauntlets were also allowed.

I am seeking other Medicare patients who have been denied any of the items they need to treat their lymphedema within the last 60 days. I will file appeals on their behalf. This is a win-win situation. If I win the case you get reimbursed for your sleeves and bandages. If I lose your case we get to appeal at a higher level. We've got to let Medicare know there is a problem with the treatment of lymphedema patients.

Please contact me privately at <> if you wish to help me help you. I do not charge for this service.

Bob Weiss, MS
Lymphedema Treatment Advocate
User avatar
Site Admin
Posts: 2175
Joined: Thu Jun 08, 2006 9:07 pm

Return to Advocacy and Governmental Resources

Who is online

Users browsing this forum: No registered users and 9 guests