Compression stockings information for authorizers and vendors

1. Authorizing compression garments

Alberta Aids to Daily Living (AADL) accepts applications from current AADL authorizers who are at least a 0.6 FTE and are a registered occupational therapists, physical therapists or registered nurse with additional training in the circulatory system, lymphedema, lower leg assessments, Ankle Brachial Index, Toe Brachial Index, and Toe pressures.

Applicants must complete the Authorizer Application for Product Range: Compression Garments PDF icon and review the online module. Applications can be faxed to AADL.

AADL will add the product range for Compression Garments to an authorizerís product ranges once all requirements are met.

2. Conditions for funding of compression garments

CEAP 4 and 5 and Chronic Lymphedema. Read more about these diagnosisí and their clinical signs and symptoms

3. Values (ABI, TBI, Toe pressures) outside of AADL policy

A vascular surgeon, physician or Nurse practitioner, who have expertise in lower leg assessment/Lymphedema, may prescribe the garments for clients who's values are outside of AADL policy.

4. Certified Lymphedema Therapists (CLT) or Specialty Assessors (SA) requirements

Authorizers who work with clients with lymphedema may be granted permission to authorize compression garments without a physician prescription if they meet additional criteria (Certified Lymphedema Therapist, Specialty Authorizer). CLTís and SAís have the additional skills and knowledge to determine when a client has lymphedema and the appropriate therapies required to manage it.

5. Clients not eligible for AADL funds even with a prescription

Although a physician may recommend compression garments for prevention, AADL will not fund compression garments outside of the parameters as stipulated. It is important to explain to the client that compression is still important for prevention and to follow the physicianís recommendations.

AADL does not provide compression garments for short term interventions, edema management, and hypotension or wound management. For some contraindications such as cellulitis, it may mean ensuring the client is under active treatment to resolve the issue and then authorizing the garments once resolved.

6. Documentation required for compression garments

For cases of chronic venous insufficiency an AADL lower leg assessment form must be attached. 1250's without the Lower leg assessment will be returned to the authorizer which will delay the client from obtaining the stockings.

7. Clients with an active ulcer/sore

You must wait until the wound heals prior to sending in the Authorization form.

8. Number of garments to order if only one of the clientís legs is affected

The client will be eligible for 2 garments per limb per year to meet their basic needs.

9. Order the maximum quantity of garments based on assessed need

  • You must order according to the clients assessed need and not product maximumís.
  • AADL provides a quantity maximum of 3 pairs, to accommodate cases in which the stockings do not last the full 6 months.
  • Quantities are based on life expectancy of the garment. Readymade garments are designed to last 6 months and therefore 2 per year are required to meet a personís basic needs. The client is expected to wash the garments at night so they can reapply them the next day.
  • Custom garments have a maximum of 2 per year per limb.
  • If you combine both custom and readymade, authorize 2 custom for the one limb and one pair of readymade for the other limb.

10. Providing compression garments to clients

AADL has observed that some vendors are providing clients with all 3 pairs of compression at once. As per AADL policy, clients may receive one pair initially to determine: compliance, adequacy of compression (especially important when a lower leg ulcer has just closed), and the length of garment meets the clientís needs.

If all 3 pairs are provided at once, the client will be responsible for the cost of any stockings that may be required if the original compression authorized does not meet the clientís clinical needs.

11. Clients wanting pantyhose but only authorized for below-the-knee compression stockings

You may authorize for the below knee stocking and the client can pay the additional charges for the pantyhose length. The client is responsible for any cost sharing and the additional charges, such as the up-grade cost to pantyhose. It is also recommended that this is documented on the 1250 form.

12. Ordering thigh high stockings or panty-hose if clinically warranted

Authorizations for thigh high stockings must include on the lower leg assessment form, indication of hemosiderin staining and/ or ropey torturous veins above the knee. If panty hose are being requested, there must be indication of hemosiderin staining and/or ropey torturous veins into the groin.

13. Ordering 2 different grades of compression or 2 different types of stockings

You may order the different stockings. However, the total cannot exceed the maximum quantity for one type of stocking.
In situations when the client needs a combination of custom and readymade garments, quantity maximums are affected.

14. Information required when custom garments are ordered

Custom made compression garments are funded only when readymade garments do not meet the clientís needs. The authorizer must provide rationale for custom made garments on the 1250. Authorizers must describe irregular fit, using descriptive terms such as inverted champagne or tubular.

When claiming that the clientís measurements are outside readymade sizes, you must include the clientís measurements on the 1250 form to assist AADL in confirming eligibility.

15. AADL product codes, maximum quantities and costs

16. Clients no longer eligible to receive funding for compression stockings

The Alberta Aids to Daily Living (AADL) program provides funding for support stockings for specific medical conditions based on a medical assessment of need. To be eligible for coverage of support stockings through AADL, a client must have signs and symptoms of CEAP 4 or 5; a conditions where there is poor return of blood from the feet and legs back to the heart or Chronic Lymphedema.

Prior to September 2005, clients could receive AADL coverage for support stockings by presenting a prescription from their doctor. However, it was found there were individuals receiving the support stockings that had conditions other than CEAP 4 or 5 or Chronic Lymphedema and complications, such as chronic wounds or amputations were occurring. As a result of these concerns, AADL implemented a best practice guideline. Under the new AADL process, comprehensive lower leg assessments are mandatory to prevent possible complications.