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Lymphedema Compression Bandages and Garments are Prosthetics

PostPosted: Tue Aug 22, 2006 5:00 am
by patoco
Sent: Tuesday, August 22, 2006 4:25 AM
Subject: Compression Bandages and Garments are Prosthetics

As many of you know, I have been assisting Medicare beneficiaries in appeals of their denials of lymphedema treatment materials. My legal and medical arguments, supported by references to medical sources as well as relevant Medicare laws and policies, made the case that compression therapy materials (specifically: compression bandaging systems; compression garments; directional flow pads and garments; non-elastic compression devices) are reasonable and medically necessary in the treatment of lymphedema according to current medical standards. Furthermore, they meet all of the statutory requirements of prosthetics according to Section 1861(s)(8) of title XVIII of the SSA and should not be denied because “they do not fit any statutory benefit category”.

On August 16, 2006 a U.S. Administrative Law Judge in Southern California found that certain items received by a Medicare beneficiary for the treatment of lymphedema “were reasonable and necessary for reimbursement as a prosthetic device” and that “payment is to be made on the beneficiary's behalf for the reasonable and necessary medical services rendered and billed.” The items included compression bandaging materials, a directional flow sleeve, compression arm sleeve and gauntlets. Visits to a lymphedema treatment center for the purposes of evaluation and measurement and fitting of the sleeves and gauntlets were also allowed.

I am seeking other Medicare patients who have been denied any of the items they need to treat their lymphedema within the last 60 days. I will file appeals on their behalf. This is a win-win situation. If I win the case you get reimbursed for your sleeves and bandages. If I lose your case we get to appeal at a higher level. We've got to let Medicare know there is a problem with the treatment of lymphedema patients.

Please contact me privately at <> if you wish to help me help you. I do not charge for this service.

Bob Weiss, MS
Lymphedema Treatment Advocate