Medicare To Expedite Coverage For Lymphedema Pumps

HHS Secretary Tommy G. Thompson announced that Medicare will expedite coverage of pneumatic compression pumps to make it easier for Medicare beneficiaries with lymphedema to take advantage of the technology. 

Secretary Thompson announced the expanded Medicare coverage while working at the Baltimore offices of the Health Care Financing Administration (HCFA). The Secretary moved HHS headquarters to the Health Care Financing Administration's offices in Baltimore this week to give HHS and HCFA staff an opportunity to work together to build a stronger HCFA. 

Medicare's new coverage policy eliminates language that made these compression pumps the treatment "of last resort" for beneficiaries suffering from lymphedema, an accumulation of lymphatic fluid causing abnormal swelling of the arms, legs, breast, neck or head that often develops when lymph nodes are removed during surgery.  Breast cancer surgery is the most common cause of the condition in the United States. 

"It's important to make effective technologies available to Medicare beneficiaries when it helps them the most," Secretary Thompson said. "This coverage decision simplifies Medicare policy to allow older Americans who need these pumps to get them more quickly and easily." 

Under the new coverage policy, Medicare will cover the pump if a beneficiary first undergoes an initial therapy of conservative care, which includes elevation, exercise and the use of a compression garment, for at least four weeks without results.  The new policy eliminates the need for a Medicare beneficiary to purchase a more expensive, custom-made garment before being eligible to receive a pump. 

Although lymphedema is not life-threatening, it can significantly impact the quality of life for sufferers.  The condition can be uncomfortable and painful, as well as disfiguring and disabling.  In some cases, it can lead to cellulitis or lymphangitis. 

"HCFA's new coverage process is helping Medicare make the right decisions, based on scientific evidence, on when the program should cover new items, services and procedures," said Jeffrey Kang, M.D., director of HCFA's Office of Clinical Standards and Quality. "By getting this device, which is proven effective, to beneficiaries sooner, we are improving the health care available to the senior citizens and disabled Americans who rely on Medicare." 

Details of this coverage decision are available at www.hcfa.gov/coverage/8b3-z.htm