Does Medicare Cover Compression Stockings for Venous Insufficiency?
Understand Medicare coverage for compression stockings for venous insufficiency: eligibility criteria, process, and patient financial responsibilities.
Venous insufficiency is a common condition where leg veins struggle to return blood to the heart, often leading to swelling, pain, and skin changes. Compression stockings are specialized garments that apply graduated pressure to the legs, aiding blood flow and reducing symptoms. Many individuals wonder if Medicare, the federal health insurance program, helps cover the cost of these medical devices. This article will clarify how Medicare addresses coverage for compression stockings when prescribed for venous insufficiency.
General Medicare Coverage for Compression Stockings
Medicare Part B generally covers durable medical equipment (DME), which includes items like wheelchairs, oxygen equipment, and hospital beds. However, Original Medicare does not typically classify compression stockings as DME for general purposes. Medicare does provide coverage for compression stockings under specific medical conditions, such as lymphedema or when used to treat venous stasis ulcers. Over-the-counter, non-medical-grade compression stockings are not covered.
When prescribed for a qualifying condition, Medicare Part B considers compression stockings necessary for wound care, especially for venous ulcers. Their role in managing severe complications of venous insufficiency can lead to coverage. The distinction lies in their medical purpose and the specific diagnosis supporting their use.
Specific Requirements for Coverage
For Medicare to cover compression stockings for venous insufficiency, a diagnosis of severe venous insufficiency with documented venous stasis ulcers is required. These ulcers are open wounds on the lower leg caused by poor blood circulation. The stockings are considered an important part of the wound treatment and management.
A written prescription from a qualified physician is required. This order must state the medical necessity for the compression stockings. The stockings must be medical-grade with specific compression levels, often 20-30 mmHg or higher. The physician’s medical records must document the diagnosis, condition severity, and how the stockings are integral to the treatment plan for venous stasis ulcers.
Process for Obtaining Covered Stockings
The process begins with a consultation with your healthcare provider to assess your condition and confirm the medical necessity for compression stockings. During this visit, the physician will determine if venous stasis ulcers are present and if compression stockings are an appropriate treatment. A face-to-face encounter with the prescribing physician or other authorized practitioner must occur within six months prior to the written order. This encounter ensures the beneficiary was evaluated for a condition supporting the need for the item.
After medical necessity is established, your physician will provide a prescription for the compression stockings. This prescription should specify the type of stocking, the required compression level, and the quantity needed. You must obtain the stockings from a durable medical equipment (DME) supplier that is enrolled in Medicare and accepts assignment. Medicare provides an online directory to help locate approved suppliers.
A proper fitting for the compression stockings by the supplier is important to ensure their effectiveness and comfort. The Medicare-approved supplier typically handles the claim submission to Medicare on your behalf.
Patient Costs and Financial Responsibilities
For compression stockings covered under Medicare Part B, beneficiaries are responsible for out-of-pocket costs. The annual Medicare Part B deductible must be met before Medicare begins to pay; for 2025, this is $257. After the deductible is satisfied, Medicare Part B typically covers 80% of the Medicare-approved amount for the stockings.
The patient is responsible for the remaining 20% coinsurance. This coinsurance applies to the Medicare-approved cost, which may differ from the supplier’s initial charge. If a supplier does not accept assignment, they can charge more, and you may be responsible for the difference. For those with a Medicare Advantage (Part C) plan, cost-sharing may differ, but medical necessity criteria remain consistent with Original Medicare.