Medicare Part B covers medical services and supplies, including Durable Medical Equipment (DME). Compression stockings are specialized medical items that can be classified as DME, but their coverage is subject to highly specific rules within the Medicare program. Part B covers compression stockings only when they are deemed medically necessary for the treatment of certain severe conditions, requiring a physician’s prescription and specific documentation. Coverage is not automatic, and the circumstances under which Medicare will pay for them are narrowly defined.
Specific Medical Conditions Required for Part B Coverage
Medicare Part B covers compression stockings only when they are prescribed to treat particular medical conditions, primarily those involving severe compromise to the circulatory or lymphatic system. The most common qualifying scenario is the treatment of open venous stasis ulcers. These are chronic, non-healing wounds typically found on the lower legs resulting from severe chronic venous insufficiency. In this context, the compression stockings are covered because they are classified as a form of “surgical dressing” or wound care essential for the ulcer to heal.
A more recent expansion in coverage, enacted through the Lymphedema Treatment Act, allows Part B to cover compression garments for patients diagnosed with lymphedema. Lymphedema is a condition where a compromised lymphatic system causes fluid accumulation and chronic swelling. For this diagnosis, Medicare covers up to three daytime garments every six months and two nighttime garments every two years for each affected body part.
For coverage to be approved, a physician or other authorized health care provider must issue a prescription and document the medical necessity of the garments. The prescription must specify the diagnosis, the type of garment, and the required compression level, which is often a medical-grade pressure like 30-40 mm Hg.
Standard Uses Not Covered by Part B
Original Medicare does not cover compression stockings for general purposes, routine prevention, or comfort-related issues. This includes general leg swelling (edema) not related to a qualifying condition or the routine management of common vein problems like varicose veins. Compression garments used for prevention of deep vein thrombosis (DVT) outside of an inpatient hospital stay are also excluded from coverage.
Medicare considers these non-covered uses to be for comfort, convenience, or general wellness, which fall outside the scope of Part B’s medical benefit. Preventative or low-pressure support stockings, which can be purchased over-the-counter, are generally the responsibility of the patient.
Coverage Through Medicare Advantage and Other Parts
Medicare Advantage plans (Part C) offer an alternative way to receive Medicare benefits through private insurance companies. These plans are required to cover all the same medically necessary services as Original Medicare (Parts A and B), including compression stockings for venous stasis ulcers and lymphedema.
Many Medicare Advantage plans offer supplemental benefits that may cover routine compression stockings beyond the standard Part B coverage. These extra benefits often take the form of an allowance for over-the-counter medical supplies, which can be used to purchase lower-pressure compression garments. Patients should review their specific Part C plan’s Evidence of Coverage to determine if these additional benefits are available.
Medicare Part A, which covers inpatient hospital and skilled nursing facility stays, may cover compression stockings if they are administered as part of the patient’s care during a covered inpatient stay. This coverage is bundled into the facility bill and is not a separate benefit for the patient to claim. Once the patient is discharged, Part B rules apply for any subsequent compression garment needs for use at home.
Patient Costs and Necessary Supplier Requirements
When compression stockings are covered under Medicare Part B, the patient is responsible for a portion of the cost. After the annual Part B deductible is met, the patient typically pays a 20% coinsurance of the Medicare-approved amount for the equipment. Medicare pays the remaining 80% of the approved amount.
A crucial requirement for coverage is that the compression stockings must be provided by a supplier enrolled in Medicare as a Durable Medical Equipment (DME) provider. For the claim to be processed smoothly and to limit the patient’s financial liability, the supplier must also “accept assignment.” Accepting assignment means the supplier agrees to accept the Medicare-approved amount as the total payment for the item.
If a supplier does not accept assignment, they are permitted to charge the patient more than the Medicare-approved amount, which can result in higher out-of-pocket costs. Patients should always confirm that their medical provider and supplier are Medicare-enrolled and accept assignment before obtaining the covered compression garments. This ensures that the patient’s financial responsibility remains limited to the standard deductible and 20% coinsurance.