Medicare Coverage of Lymphedema Pumps
What It Is
A medical device used at home for patients suffering from lymphedema (swelling, often arm or leg) due to a lymphatic condition. These pumps are used in the treatment of lymphedema to move excess fluid out of the affected limb and return it to the cardiovascular system. They're often used at home by patients who don't have easy access to a lymphedema therapist for routine treatment.
Medicare Part B pays for the rental or purchase of a lymphedema pump if prescribed by a doctor. In addition, before the patient obtains the equipment, the prescribing doctor must send Medicare a written request for approval, called a Certificate of Medical Necessity. The equipment must be rented or purchased from a Medicare-certified medical equipment supplier.
If you have a Medicare Part C Medicare Advantage plan: Medicare Part C Medicare Advantage plans, also called Medicare Advantage plans, must cover everything that's included in original Medicare Part A and Part B coverage. But sometimes a Part C plan covers more, with extra services or an expanded amount of coverage. (Co-payments for Part C plans may also be different than those for Part A or Part B.) To find out whether your plan provides extra coverage or requires different copayments for a lymphedema pump, contact the plan directly.
What Medicare Pays
Medicare Part B pays 80 percent of the Medicare-approved amount for rental or purchase of a lymphedema pump; the patient is responsible for the remaining 20 percent.
Warning: If a device is rented or purchased from what's called a Medicare "participating supplier," the supplier can't charge more than the Medicare-approved amount. However, a supplier who's enrolled in Medicare but isn't an officially participating supplier may charge more than the Medicare-approved amount. In that case, the patient must personally pay the difference between the Medicare-approved amount and the amount the supplier actually charges (on top of the 20 percent of the Medicare-approved amount that Medicare doesn't pay).
Important: Regardless of the rules regarding any particular type of care or equipment, in order for Medicare Part A, Medicare Part B, or a Medicare Part C plan to provide coverage, the care or equipment must meet two basic requirements:
The care or equipment must be "medically necessary." This means that it must be ordered or prescribed by a licensed physician or other authorized medical provider, and that Medicare (or a Medicare Part C plan) agrees that the care or equipment is necessary and proper. For help getting your care covered, see FAQ: How Can I Increase the Odds That Medicare Will Cover My Medical Service?
The care or equipment must be provided by a healthcare provider or equipment supplier who participates in Medicare.