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Compression Garments

Compression Garments

Quest ion:

For compression garments such as sleeves for arm, hand and knee, and bras for mastectomy, our research shows they are not DMEand the HCPCScould be A6549 These are not covered by Medicare. If we supply them to the patient, can we report them on the claim?If so, what is the correct revenue code and HCPCScode, and what would the cost be non-covered and non-collectable from the patient?

Answ er:

Many compression garments are non-covered, however below-the-knee compression stockings prescribed for venous statis ulcers of the legs are status N under OPPS, which means that they are covered, but not separately paid (see HCPCSA6531, A6532, and A6545 below ) Of course, a Critical Access Hospital will be paid on a cost-reimbursement basis for all covered charges on a facility fee claim

When used as medically necessary dressing immediately following surgery, some facilities include the cost of the initial post-surgical compression garment within the charge for the surgical procedure, or as an un-coded supply charge, rather than charging post-op patients for the compression garment as a non-covered item.

Hospitals may charge non-covered compression garments on a facility fee claim by reporting the appropriate HCPCSunder revenue code 0274 (MEDICAL/SURGICAL SUPPLIESAND DEVICES (ALSO SEE062X, AN EXTENSION OF027X). If an ABN was issued to transfer potential financial liability to the beneficiary for non-covered items, the hospital should append modifier GA (Waiver of liability statement issued as required by payer policy, individual case) to the HCPCS The ABN must be delivered far enough in advance that the patient has time to consider other options, such as purchasing from a pharmacy at a lesser cost

There are several HCPCSlisted in the PDEfor compression stockings, but only one (A6549) that includes the word ?sleeve?in the description

Compression Garments

Some health plans may cover compression garments for conditions other than venous statis ulcers as will some Medicare Advantage plans Its important to check with each plan to verify coverage

Compression garments for breast prostheses are covered under Part B or Part A depending on the setting as indicated on this Medicare page: Breast Prosthesis Coverage (medicare.gov)

There is good news for 2024! The Lymphedema Treatment Act was passed by Congress on December 23, 2022, which will add compression garments as a billable item effective January 1, 2024 I have provided a link to read about the efforts of a few to make compression garments a covered item