CurrentBlue Cross Blue Shield - Rhode IslandPolicy N/A

Compression Garments and Stockings Coverage Criteria

This policy governs coverage and payment for compression garments and stockings provided as durable medical equipment to Medicare Advantage and commercial members of Blue Cross Blue Shield of Rhode Island.

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyCompression Garments and Stockings Coverage Criteria

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateN/A

Key ActionObtain a physician order and ensure fitting/measuring by a trained individual for coverage.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

8 or 4max units / 12 months

20–30 to 50+prescription pressure range

MA & Commercialplan types

Coverage Criteria

inv-01: Coverage Criteria

Covered when ALL of the following are met

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Over-the-counter (OTC) support hose, stockings, and garments that are non-graduated or provide no measurable degree of compression are not covered and are the member's financial responsibility. Examples include medical support hose, fabric supports, elastic stockings with no degree of pressure, and surgical leggings. Claims for these OTC items billed as durable medical equipment may be denied.

Coding and Prescription Details

Prescription pressure range

Typical prescription pressure range20-30 mmHg up to 50+ mmHg

OTC vs prescription pressureOTC stockings are lower grade and may not be graduated; prescription stockings are graduated and have specific grades of compression

Higher-pressure requirementHigher pressure stockings require a prescription and fitting by a trained individual

Provider Actions and Billing Impact

Note

Prior Authorization

Prior authorization is not applicable for this policy.

Step Therapy

No step therapy requirements are specified for compression garments/stockings under this policy.

Documentation Required

Order and Fitting Requirement

A physician order is required and compression stockings/garments must be fitted and measured by a specially trained individual. Prescription (graduated) stockings — especially higher-pressure garments (typically 20–30 mmHg up to 50+ mmHg) — require a prescription and a trained fitter. Pre-made prescription-grade stockings are available; custom-made garments are rarely needed unless the required pressure gradient cannot be achieved with pre-made items. Allow 6–8 weeks for custom orders when applicable.

Physician order required
Fitting/measuring by specially trained individual required
Higher-pressure (20–30 mmHg to 50+ mmHg) stockings require prescription and trained fitter
Custom-made orders may take 6–8 weeks

Billing Rule

OTC Items Not Covered

Over-the-counter (OTC) support hose/stockings/garments (for example, medical support hose, fabric supports, elastic stockings with no degree of pressure, surgical leggings) are not covered and are member liability. OTC items are lower-grade, may not be graduated, and should not be billed as covered DME.

OTC non-graduated items not covered — member liability
Do not bill OTC support hose/stockings/garments as covered DME

Background

Compression garments (also called stockings, sleeves, burn garments, or gradient pressure garments) are fitted elastic support garments designed to apply a controlled pressure gradient to a body area. Their mechanism of action is to improve venous hemodynamics, reduce edema, and support circulation; they are also used in burn care. Coverage requires that the garment be ordered by a physician and obtained from a durable medical equipment (DME) provider. Prescription-grade, graduated compression typically requires measurement and fitting by a trained individual and may be provided as pre-made or custom garments (custom orders can take several weeks).

Definitions

Compression garment — definition and examples

DefinitionA typically fitted elastic support garment (e.g., stocking, burn garment, gradient pressure aid garment, sleeve) fabricated to apply varying pressure gradients to an area

PurposeImproves venous hemodynamics, decreases edema, stimulates circulation, and used in burn treatment

FormulationAvailable as pre-made or custom-made; custom orders may be needed when required gradient pressure cannot be met by pre-made garments (can take 6–8 weeks)

Over-the-counter (OTC) stockings — definition and distinction

DefinitionOver-the-counter (OTC) compression stockings are lower grade, may not be graduated, and are not equivalent to prescription graduated stockings

Coverage statusOTC support hose/stockings/garments (non-graduated) are not covered and are member liability

DistinctionPrescription stockings are graduated (pressure decreases from ankle up) and have specific grades of compression; OTC items lack these characteristics

Medical Necessity Criteria

inv-12: DME Medical Necessity — Medical necessity for coverage requires:

Medical necessity for coverage requires:

DME medical necessity: Physician order; provided by a durable medical equipment (DME) supplier; fitting and measuring by a specially trained individual when necessary; prescription required for graduated higher-pressure stockings (typical prescription pressures range from 20–30 mmHg to 50+ mmHg)

Pre-made compression garments are acceptable for most needs; custom garments are covered only when the required degree of gradient pressure cannot be met with pre-made items (custom orders may take 6–8 weeks).

Rental and Purchase Rules

Item	Rental or Purchase Rule
Compression garments/stockings (pre-made)
Purchase — Most compression garments are DME and supplied as purchased items; pre-made garments are acceptable and are provided by a DME supplier.
Compression garments requiring custom gradient pressure
Purchase — Custom-made garments are provided when the required degree of gradient pressure cannot be met with pre-made items (custom orders may take 6–8 weeks).

Replacement and Quantity Limits

Compression stockings — quantity limits

Quantity limit8 stockings or 4 pairs per 12 months

Reference noteThis unit limit applies after the initial dispensed compression garment(s)/stocking(s); see Maximum Units policy for unit limits details

Dispensing contextApplies to compression stockings provided to members when ordered by a physician and obtained from a DME provider

Documentation Requirements