Your Initial Evaluation at Self Care Therapy

Your First Appointment at Self Care Therapy Will Consist of:

• An initial evaluation including a review of your past and current health history
• A list of problems that can benefit from therapy
• Limb Measurements
• Collaboration on goals for your treatment
• A treatment plan
• An estimated course and cost estimate for achieving these goals

Possible Treatment Costs – Lymphedema Therapy

Insurance

Medicare part B covers 80% of the treatment cost after your yearly deductible is met. If you have secondary insurance it may cover the other 20%. Be aware that some secondary insurance plans have co-pays or yearly deductibles.

We accept most private insurance. Please refer to your insurance plan for coverage of Outpatient Occupational Therapy Services. Unfortunately Medicaid in NC does not cover Outpatient Occupational Therapy services.

Outpatient Therapy is not covered while you are receiving home health services under Medicare.

Bandages

There are no material costs for the initial evaluation appointment. As of January 1, 2024, the Centers for Medicare & Medicaid Services (CMS) added a new benefit category under Medicare Part B for compression bandages and supplies specifically for lymphedema treatment, therefore, it is likely your treatment supplies may be fully or partially covered. With some cases, there is also a rental option if your specific insurance does not cover lymphedema treatment.  

Compression Garments

After phase one of treatment, you will need compression garments to prevent the return of swelling and for long term management of this condition. Under the Lymphedema Treatment Act (passed by Congress in 2024), patients with a diagnosis of Lymphedema (189.0) are now able to have compression garments covered by Medicare. Medicare may cover the following if you meet the eligibility criteria:
Standard OTC and custom-fitted gradient compression garments (daytime & nighttime) for each affected body part. After reviewing your specific insurance coverage, we will better be able to explain your specific garment coverage and assist you in fitting for and ordering the correct garment for your needs.

*The most important price you pay is your effort in following the program.

*Deviations off the program usually results in longer treatment.

What To Do If You Do Not Have a Lymphedema Diagnosis:

Talk with your doctor and get a prescription specifying: diagnosis (lymphedema), affected body part(s), and that the garment is medically necessary. Below is some documentation you may provide to your doctor to assist with this process: 

Thank you for choosing Self Care Therapy for your swelling needs. Under the  Lymphedema Treatment Act (passed by Congress in 2024), patients with a diagnosis of Lymphedema are now able to have compression garments covered by Medicare.  However, your doctor has not provided us with the documentation necessary to bill compression garments to Medicare. 

Please provide this information to your doctor.

• Patient presented to our office and we believe patient has Lymphedema
• Patient presented to our office and we are questioning if patient has Lymphedema

Doctors:  If you feel that the patient has this condition please fax medical records to support this condition.  Our Fax # is 910-338-0424.