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The rules say that plans must pay for a medical service or item if regular Medicare would pay for it in this case. 
You can find this rule at 42 Code of Federal Regulations (CFR) Section 422.101. 
 
The rules say that elastic stockings are not covered because they are non-reusable supply items. Elastic 
stockings are not durable medical equipment. You can find this rule in the Centers for Medicare and Medicaid 
Services, Internet Only Manual, Publication 100-03, Medicare National Coverage Determinations Manual, 
Chapter 1, Section 280.1. 
 
The rules say that gradient pressure garments may be covered when used as dressings following burn injuries. 
You can find this rule in the Centers for Medicare and Medicaid Services, Internet Only Manual, Publication 
100-03, Medicare National Coverage Determinations Manual, Chapter 1, Section 270.5.  
 
The rules also say that compression bandages, multi-layer systems, and gradient compression wraps are 
covered only when they are used as dressings over a qualifying wound. A qualifying wound is either a wound 
caused or treated by surgery or a wound that must be debrided. A gradient compression stocking or wrap 
described by codes A6531, A6532, or A6545 is only covered when it is used in the treatment of an open 
venous stasis ulcer. Gradient compression stockings and wraps identified with codes A6531, A6532, and 
A6545 are not covered when they are used to treat the following conditions: 
 
Venous insufficiency without stasis ulcers; 
Prevention of stasis ulcers; 
Prevention of the reoccurrence of stasis ulcers that have healed; 
Treatment of lymphedema in the absence of ulcers. 
 
You can find these rules in Local Coverage Determination (LCD): Surgical Dressings L33831 and Local 
Coverage Article: Surgical Dressings-Policy Article A54563, effective for services performed on or after July 
24, 2017. 
 
The rules say external breast prostheses are covered under the Prosthetic Devices benefit (Social Security Act 
1861(s)(8)). In order for a beneficiarys supplies to be eligible for reimbursement the reasonable and 
necessary (R&N) requirements set out in the related Local Coverage Determination must be met. In addition, 
there are specific statutory payment policy requirements, discussed below, that also must be met. The diagnosis 
code must be included on each claim for the prosthesis or related item. 
 
If the patient's medical condition changes, this should be documented by the patient's treating practitioner 
submitting a new order which explains the need for a different type of breast prosthesis. The order must be kept in the supplier's files but need not be submitted with the claim. Code L8000 describes a bra with pockets that 
are intended to hold a mastectomy form or breast prosthesis held adjacent to the chest wall. Bras coded L8000 
do not include an integrated breast prosthesis (for bras with integrated breast prosthesis, see codes L8001 and 
L8002). Products described by code L8000 may be constructed of any material (e.g., cotton, Lycra, polyester or 
other materials), any size, and with or without integrated structural support (e.g., underwire). 
 
Codes L8001 and L8002 describe a bra with integrated breast prosthesis, either unilateral or bilateral, 
respectively. Products described by codes L8001 and L8002 may be constructed of any material (e.g., cotton, 
polyester or other materials), with any type or location of closure, any size, with or without integrated structural 
support (e.g., underwire). You can find this rule in the Local Coverage Article External Breast Prostheses - 
Policy Article A52478. 
 
If you want to read these Medicare rules, you can go to this website www.medicareappeal.com. 
 
The Plan contract says that the Plan covers items and services in accordance with Medicare rules.