CurrentBlue Cross Blue Shield - Rhode IslandPolicy N/A

Compression garments / compression stockings (DME)

Defines coverage for compression garments/stockings as durable medical equipment when ordered by a physician and obtained from a DME provider; excludes over-the-counter/non-prescription support hose. Notes unit limits and references related guidance.

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyCompression garments / compression stockings (DME)

Policy CodePolicy N/A

Change TypeNo material change

Effective Date

Next Review Date

Key ActionObtain a physician order and ensure measurement and fitting by a specially trained individual; file covered HCPCS codes (e.g., L8010) through a DME provider.

SourceLink

POLICY UPDATE CHANGES

No material changes

8Maximum stockings dispensed (total)

4 / 12 monthsReplacement limit after initial dispense

L8010Example HCPCS code listed

Coverage Summary

Defines coverage for compression garments/stockings as durable medical equipment (DME) when ordered by a physician and obtained from a DME provider; excludes over-the-counter/non-prescription support hose/stockings. Notes unit limits: a member may be dispensed 8 compression stockings (total) or 4 per 12 months after the initial dispense, and refers to the Maximum Units policy for pairs. Covered HCPCS code example must be filed by a DME provider.

Medical-Necessity Criteria

Medically Necessary Coverage Criteria

Compression Garments / stockings are covered when ALL of the following are met:

ALL of the following

Ordered by a physician
Obtained from a durable medical equipment (DME) provider

Unit Limits / Dispensing Frequency

A member may be dispensed 8 compression stockings (total)

Or 4 per 12 months after the initial dispensed compression garment(s)/stocking(s)

Refer to the Maximum Units policy for unit limits (pairs)

Not Covered / Member Liability

Over-the-counter (OTC) support hose/stockings/garments (medical support hose, fabric supports, elastic stockings with no degree of pressure, surgical leggings) are not covered and are member liability

Over-the-counter support hose/stockings/garments (medical support hose, fabric supports, elastic stockings with no degree of pressure, surgical leggings) — not covered and are member liability.

Provider Actions

Prior Authorization

Prior authorization

Not applicable—policy states prior authorization is not applicable.

Documentation Required

Physician order and fitting

A physician order is required and compression stockings/garments require measurement and fitting by a specially trained individual per background guidance.

Billing Rule

DME provider filing

Covered HCPCS code(s) must be filed by a DME provider.

L8010

Background

Compression garments are typically fitted elastic support garments that apply graduated pressure to improve venous hemodynamics by muscle pump function, decrease vein reflux, increase tissue pressures to reduce edema, stimulate circulation, and are used in the treatment of burn patients. They are considered Durable Medical Equipment (DME); many garments are pre-made while some require custom fabrication and specialist fitting and measurement by a specially trained individual and a physician order.