Description

Fabric support garments are stockings or sleeves usually made of elastic, which may be utilized for conditions such as burn injuries, prevention of deep vein thrombosis (DVT), severe edema, venous insufficiency or venous leg ulcers with the goal of reducing swelling and/or scarring.

For information regarding custom-made fabric support garments for the treatment of lymphedema, please refer to Lymphedema – Diagnosis and Treatment Medical Coverage Policy.

Coverage Determination

Humana members may be eligible under the Plan for fabric support garments when the following criteria are met:

• Custom-made (sewn to the measurements of the individual) body garments following burns; OR
• Custom-made (sewn to the measurements of the individual) fabric supports for individuals with conditions such as risk of DVT, severe edema, venous insufficiency or venous leg ulcers who have documented failure of 3 months of conservative measures such as over-the-counter (OTC) support devices and exercises

Note: The criteria for fabric support garments are not consistent with the Medicare National Coverage Policy and therefore may not be applicable to Medicare members. Refer to the CMS website for additional information.

Coverage Limitations

Humana members may NOT be eligible under the Plan for custom-made fabric supports for any indications other than those listed above. All other indications are considered not medically necessary as defined in the member’s individual certificate. Please refer to the member’s individual certificate for the specific definition.

Humana members may NOT be eligible under the Plan for fabric support garments, which are not custom-made for the individual, for any indication. These types of support garments are not custom-sewn for the individual’s measurements but rather come in premade sizes (eg, small, medium, large, short, etc.). Although they may be prescribed by a health care practitioner, these are also available without a prescription and may be obtained OTC and are therefore generally excluded in the certificate. In the absence of a certificate exclusion for OTC items, these support garments are considered not medically necessary as defined in the member’s individual certificate. Please refer to the member’s individual certificate for the specific definition.

Background

Additional information about burns, DVT and venous insufficiency may be found from the following websites:

• American Society of Plastic Surgeons
• American Venous Forum

Medical Alternatives

Alternatives to fabric support garments include, but may not be limited to, the following:

• Dietary changes
• Exercise
• Limb elevation
• Weight control

Physician consultation is advised to make an informed decision based on an individual’s health needs.

Any CPT, HCPCS or ICD codes listed on this medical coverage policy are for informational purposes only.

Do not rely on the accuracy and inclusion of specific codes. Inclusion of a code does not guarantee coverage and or reimbursement for a service or procedure.