Lymphedema Treatment Act: Medicare Pays For Lymphedema Products
In January 1, 2024, Medicare started paying for products used to treat and manage lymphedema. Below is general information about the Lymphedema Treatment Act (LTA).
Eligibility For Medicare Coverage Of Lymphedema Products
The first step in determining whether you are eligible to receive coverage of lymphedema products under the Lymphedema Treatment Act is to answer these simple questions:
- Do you have Medicare Part B coverage?
- Have you been diagnosed as having lymphedema (a chronic condition that causes swelling in the body's tissues) and will use the items to treat your condition?
- Have you seen an authorized practitioner in the past 6 months, and have they documented a plan of care for treating your condition, along with prescribing the items you are seeking?
- Do you have a SIGNED prescription from your authorized practitioner for these items?
- Has your medical condition been sufficiently documented in your medical record to substantiate the need of the items?
Note that documentation must include items such as: diagnosis codes; stage/phase of lymphedema; duration of treatment/need of products; anatomical location(s) requiring treatment; type, description and quantity of products needed for treatment; measurements for compression garments; frequency of product replacement; and name of prescribing medical practitioner.
If you have answered "yes" to ALL of the above questions, then it is likely that you are eligible to have Medicare to pay for your lymphedema products. It is important to note, however, that Medicare coverage is limited based on established reimbursement rates and that not all lymphedema products may be covered.
If you have any further questions about obtaining lymphedema products under the Lymphedema Treatment Act, please feel free to email us at lta@bandagesplus.com and we will help answer your questions.
Click here to see a printable version of our Medicare Coverage For Lymphedema Supplies Checklist.
How To Order Lymphedema Products From Bandages Plus
Medicare will only pay for lymphedema compression garments, lymphedema compression wraps, and lymphedema bandaging supplies that are purchased through an enrolled Medicare DMEPOS (Durable Medical Equipment, Prosthetic and Orthotic Supplies) supplier.
Bandages Plus is NOT a Medicare DMEPOS supplier, and therefore we are not be able to provide lymphedema products under the LTA.
However, you might still prefer to order from us (by phone or on the website) if you:
- are not eligible for coverage under the LTA
- need your lymphedema products and supplies quickly
- would like to avoid the hassle of finding and ordering from a DMEPOS supplier
- need more garments or lymphedema supplies than what the LTA will allow in a 6 month period
- would like to purchase a higher quality product than what is covered under the Medicare reimbursement rates
- would like to save money (because buying the product directly from us would be less expensive than paying your Medicare deductible and co-pay)
- prefer not to wait for your garments and supplies and instead, would like to submit your claim directly to Medicare for reimbursement (see Submitting Your Bill For Lymphedema Products Directly To Medicare For Reimbursement below for details on how to submit to Medicare for reimbursement).
About The Lymphedema Treatment Act
The Lymphedema Treatment Act, which created a new benefit category in Medicare, passed in December 2022 and took effect on January 1, 2024. The federal law was designed to improve Medicare coverage for products that help treat and manage lymphedema.
If you have been diagnosed with lymphedema, and your doctor or other health care provider has prescribed compression garments, wraps, bandages, or certain supplies, Medicare Part B will cover the cost of these lymphedema products. Note that your deductible and 20% co-pay will still apply.
What Lymphedema Products Does Medicare Cover
Medicare will pay for standard and custom-fitted products for each affected part of your body, including:
- compression garments (daytime and nighttime compression garments that offer different levels of compression)
- compression wraps (gradient compression wraps with straps)
- compression bandaging (compression bandaging systems and supplies)
- lymphedema accessories (such as fillers, lining, padding, and zippers)
- lymphedema aids (such as doffing and donning aids, lower limb butlers, and foot slippers)
Limits Of Medicare Coverage For Lymphedema Products
The Medicare Part B coverage for lymphedema products is limited to:
- Daytime Compression Garments: 3 daytime compression garments per affected body part, every 6 months.
- Nighttime Compression Garments: 2 nighttime compression garments per affected body part, every 6 months.
- Bandaging Supplies: There is no set limit on bandaging supplies.
- Lymphedema Accessories: There is no set limit on lymphedema accessories; Medicare coverage will be determined on a case-by-case basis, depending on the patient.
Note that Medicare coverage also extends to replacement of compression garments that are lost, stolen, or irreparably damaged, as well as new compression garments that are needed because a patient has experienced a change in limb size.
Medicare Part B Coverage: Deductible And Co-Pay
If you have Medicare Part B coverage, you will pay your annual Part B deductible (if it has not already been met) and a 20% insurance co-pay for all lymphedema products.
Submitting Your Bill For Lymphedema Products Directly To Medicare For Reimbursement
You can purchase lymphedema products from Bandages Plus and file a claim directly with Medicare. You can find information on how to file a claim, along with the forms that you will need, on the Medicare website: How do I file a claim?
Please note that, other than providing an itemized bill for the lymphedema products purchased from us, Bandages Plus will not be able to assist you in submitting a claim directly with Medicare.
Medicare Billing Codes
With the implementation of the Lymphedema Treatment Act, the Centers for Medicare and Medicaid Services (CMS) has created several new Healthcare Common Procedure Coding (HCPC) System Codes which reflect specific lymphedema products used to treat lymphedema. These codes are required for billing treatment items under the LTA. Click here to see the Healthcare Common Procedure Coding (HCPC) System Codes for lymphedema products covered under the LTA.
Medicare Advantage Coverage
If you have Medicare Advantage, your out-of-pocket costs will vary, depending on the specific terms of your plan. It is likely that your lymphedema products will be subject to the same co-pay and deductibles as supplies covered under the DMEPOS section of your policy.
Medicaid And Private Insurance Coverage
The Lymphedema Treatment Act was does not apply to Medicaid or private insurance policies. However, some private health insurance plans do cover lymphedema products. We encourage you to contact your health insurer to see whether they will cover products for the treatment of lymphedema, and any other questions that you might have.
Further Information
For more information on the Lymphedema Treatment Act and Medicare coverage of lymphedema products, you can visit Centers for Medicare & Medicaid Services: Lymphedema Compression Treatment Items.
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See Related Lymphedema Treatment Act Topics:
Why Order Compression Garments From Bandages Plus
Medicare Coverage For Lymphedema Supplies: A Checklist
FAQs About The Lymphedema Treatment Act