Beginning January 1st, 2024 Medicare will cover the use of graduated compression stockings, adjustable compression wraps, night time compression garments, and bandaging for patients diagnosed with lymphedema.  To learn more about Medicare coverage for lymphedema garments go to:

Compression garments are usually not a covered Medicare item for most indications. There is a Medicare exception to accept compression stocking claims when a patient has a diagnosis of an active venous stasis ulcer.  This does require specific documentation and a prescription for graduated compression stockings or adjustable compression wraps with compression levels of 30-40 mmHg or 40-50 mmHG.  

Commercial insurance plans that are provided through an employer or purchased through various state offerings for the Affordable Care Act are starting to adjust policies to follow Medicare guidelines.  Check your specific policy as insurance coverage can vary from each state, insurance provider, and even within each plan. Compression therapy product are listed under Durable Medical Equipment and may be subject to plan deductibles. Lastly, note that insurance coverage can be determined by the diagnosis or ICD-10 code the healthcare provider documents and prescribes.

Are orthopedic bracing products covered by Medicare or health insurance? 

Most orthopedic bracing that provides structural support with a rigid material, like aluminum or carbon, or that provide functionality and deemed medically necessary are generally covered by Medicare and most commercial health insurance plans.  To qualify, the orthopedic brace must be accepted by Medicare and given a PDAC letter of approval. Products must be fit and billed through an approved DME (durable medical equipment) provider.  In most cases, Medicare or the insurance carrier may only cover a portion of the brace, so be prepared for some form of co-payment.  

Medicare or commercial insurance coverage for supports for knee, ankle, Achilles, elbow, and wrist that are categorized for prophylactic use can be covered at times. Orthopedic supports are commonly used to provide pain relief in joints that have previously been surgically repaired or to provide added stability during activity.  

Are compression pumps covered by Medicare or health insurance? 

Approved Medicare pneumatic compression devices are a covered benefit with a diagnosis of lymphedema or chronic venous insufficiency with an open venous leg ulcer that has been treated for at least 6 months.  Medicare requires a prescription as well as some specific clinical notations from a physician prior to authorization of the compression pump. Most commercial health care insurance providers follow these same Medicare guidelines.  

Compression pumps must be billed and set up by an approved Medicare DME who can determine if a patient qualifies for insurance coverage. In many cases, the entire cost of the compression pump is not covered 100% and the patient may be responsible for a co-pay.  

How can I find out if my medical product is covered by my health insurance? 

First, it will be important to have a clear diagnosis with a prescription from your health care provider to properly obtain the coverage information. Your healthcare provider may have some preliminary information but will likely defer to your carrier.  

Check your insurance plan benefits for DME coverage. Make note of any deductibles that may need to be met prior to the insurance activating to cover these costs. There may also be co-pays based on the product category and type of insurance.  Your insurance carrier and your local medi dealer can likely provide more detailed guidance based on your specific situation. 

What documentation is needed to submit a health insurance claim for medical products? 

In most cases, a DME (durable medical equipment) provider will need the following information to determine coverage or submit a claim: 

  • Beneficiary name/ policy # 
  • Prescription with diagnosis (ICD-10 code)/Certificate of Medical necessity 
  • Product Description / HCPCS product code 
  • Quantity/ Duration of use 
  • Refills