Are Huggers covered by Insurance as a post-surgical and lymphedema gradient compression bra?

Yes! Huggers are eligible for coverage by most public & private insurance as a pocketed post-surgical bra / binder and lymphedema bra or garment. Yay!

Our Huggers are eligible for coverage by most private and public insurance as a pocketed post-surgical bra and lymphedema gradient compression bra or garment for 24/7 (day/night) use, particularly during key recovery times.  Specific eligibility and coverage per patient requirement to be determined by your Insurance Provider or Coordinator. 💛

Are you a Medical Professional?

Typical HCPCS Codes utilized, to be confirmed by your Insurance Provider or Coordinator specific to your patient's requirements, are:

• Post-Surgical Pocketed Compression Bra / Binder -
  • L8000, L8001, L8002, L8015

• Lymphedema Gradient Compression Bra and Gradient Compression Garment –
  
  • A6528,  A6568, A6549, A6589
    • Requires Lymphedema Diagnosis: I89.0, I97.2, 197.89, Q82.0

• • Links to additional Medicare information resources:
    • CMS.GOV - Fee Schedule
    • CGSMEDICARE.COM - Code Reference
    • DMEPDAC.COM 
      • Lymphedema Compression Treatment Items - Correct Coding and Billing Revised - March 5 2024
      • List of HCPCS Codes that require a PDAC Verification Letter
    • Understanding CMS Rules and Medicare Compliance - Presentation by Noridian & CGS - March 2024

• • • • Page 35 - 49 - Lymphedema Compression Treatment Items
      • Page 50 - 57 - Jurisdiction Resources and Contact Information
      • Page 58 - National Provider Enrollment (NPE) Information

Are you a Patient?

Here are some possible resources to assist in the verification and coordination of insurance coverage for your post-surgical pocketed compression bras and/or lymphedema compression bras and garments:

• Ask your Local Store  Give your local Store a call to see if they can assist you with a Hugger & insurance coordination. Don’t see your Store? Let us know and we can reach out to them :)
  
  
• A few online insurance verification & coordination providers available to you in the US (list is not exclusive):
  • Compression Care
  • SunMED Medical
• Private Insurance: Reach out to your private insurance provider to request coverage verification and reimbursement information.

• Medicare Lymphedema Bra and Garment coverage information link:
  • MEDICARE.GOV

For your convenience, we provide a digital receipt/invoice with every Prairie Wear order confirmation e-mail that you or your patient can submit for reimbursement requests. 

Please note, Prairie Wear does not coordinate, verify or process insurance requests and while all information in this document is believed to be correct at the time of writing, this document is for educational purposes only and does not purport to provide legal advice. - we just make really awesome compression bras that are made to help you & your patients feel better & get better.

Thank you for this opportunity to be a part of your support team, we appreciate it 💛