Mary K., In re

(HHS, SSA Office of Hearings & App. Mar. 14, 1995) ; Clearinghouse Number: 50806

Description

Medicare Claimant Entitled to Coverage for Purchase of Jobst Venous Pressure Gradient Supports

Abstract

The administrative law judge (ALJ) has held that claimant is entitled to Medicare reimbursement for Jobst venous pressure gradient supports. Claimant underwent a radical groin dissection for a malignant melanoma in 1977. During the period at issue, claimant suffered from postphlebitic syndrome and severe lymphadema. In 1988, claimant’s physician prescribed Jobst stockings to treat claimant’s lymphadema; the custom-made stockings have been replaced on two subsequent occasions. Medicare denied coverage for the stockings, and claimant appealed. The ALJ found that the venous pressure gradient supports, which prevent the back flow of blood and lymph when the small valves in the veins and lymphatics are deficient or missing, replace part of the circulatory and lymphatic systems. The ALJ held that the supports meet the guidelines for durable medical equipment because they (1) can withstand repeated use, (2) are primarily and customarily used to serve a medical purpose, (3) generally are not useful to a person in the absence of an illness or injury, and (4) are appropriate for use in the home. Accordingly, the ALJ held that claimant was entitled to Medicare reimbursement for the purchase of the supports.

Additional Information

Attorney Information
Claimant represented by Lynne Berry, Medicare Advocacy Project, Greater Boston Legal Services, 197 Friend St., Boston, MA 02114, (617) 371-1234.
Docket Date
1995-03-14 00:00:00+00:00

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