Compression stockings are medical-grade garments designed to apply graduated pressure to the lower extremities, promoting better blood flow back toward the heart. These therapeutic stockings differ significantly from lower-pressure, non-prescription support socks. Because of their high cost, especially for custom-fitted varieties, understanding Medicare coverage is necessary. Coverage for these items is highly conditional and frequently misunderstood by beneficiaries.
When Part B Pays for Compression Stockings
Medicare Part B covers outpatient medical services and Durable Medical Equipment (DME). Part B covers compression stockings only under narrow circumstances, primarily due to recent legislation that expanded coverage for two specific medical conditions. The first condition is lymphedema, which is chronic swelling caused by a compromised lymphatic system. The Lymphedema Treatment Act, effective in 2024, mandates Part B coverage for medically necessary lymphedema compression treatment items.
This lymphedema coverage is comprehensive, including standard and custom-fitted garments for both daytime and nighttime use, as well as bandaging supplies. To ensure the garments remain effective, the benefit is subject to specific frequency limits. Patients are allowed three daytime garments per affected body part every six months. They may also receive two nighttime garments per affected body part every two years, along with necessary accessories like donning and doffing aids.
The other narrow exception for Part B coverage is when compression stockings treat an open venous stasis ulcer. In this context, the stockings are considered a necessary surgical dressing or wound care item, not a device for general circulation problems. Coverage requires the stockings to be graduated compression, often with pressure levels of 30-40 mmHg or 40-50 mmHg, and prescribed as integral to wound healing. Part B does not cover stockings prescribed for general conditions like varicose veins, chronic venous insufficiency without an ulcer, or general leg swelling, as these uses are not deemed medically necessary under the program’s criteria.
Medicare Advantage Options for Coverage
Because Original Medicare maintains restrictive criteria, many beneficiaries explore coverage through Medicare Advantage (Part C) plans. Medicare Advantage plans are offered by private insurance companies approved by Medicare. While these plans must provide at least the same level of benefits as Original Medicare, they often include supplemental benefits that Part B does not offer.
These extra benefits can create a coverage pathway for compression stockings otherwise denied by Part B. Some Part C plans may cover compression stockings for conditions like chronic venous insufficiency or as a preventative measure, provided the plan deems them medically necessary. This coverage is often found under the plan’s allowance for over-the-counter medical expenses or specific DME benefits.
Accessing this alternative coverage requires reviewing the specific plan’s Evidence of Coverage (EOC) document. Coverage rules, including the need for a physician’s prescription and prior authorization requirements, are determined by the individual Part C plan. The plan may require a physician to document a specific diagnosis to justify medical necessity, even if that diagnosis is broader than the two conditions covered by Part B.
Navigating Prescriptions and Patient Expenses
Securing coverage for compression stockings requires adherence to specific protocols, whether through a Part B exception or a Part C supplemental benefit. The first step involves obtaining a formal prescription from the treating physician, which acts as the Certificate of Medical Necessity (CMN). This documentation must include the patient’s diagnosis using the proper ICD-10 code, the product description, and the required compression level, such as 30-40 mmHg, to distinguish it from non-therapeutic varieties.
Once the prescription is secured, the item must be obtained from a supplier enrolled in Medicare as a Durable Medical Equipment (DME) provider. For smooth coverage processing, this supplier must also agree to accept assignment. Accepting assignment means the supplier accepts Medicare’s approved amount as full payment, which limits the amount the patient can be charged.
The patient’s out-of-pocket financial liability under Part B is 20% of the Medicare-approved amount for the DME. This coinsurance applies after the beneficiary has met the annual Part B deductible, which is $257 in 2025. If the deductible has been met, Medicare pays 80% of the approved cost, and the patient is responsible for the remaining 20%. If coverage is through a Medicare Advantage plan, the cost-sharing structure, including deductibles and copayments, follows the rules established by that specific plan.