Effective January 1, 2024, Medicare is expanding its coverage to include lymphedema compression treatment items for beneficiaries under Medicare Part B. This development offers vital support for those dealing with lymphedema, a chronic condition characterized by swelling in the body's tissues.
Medicare will now cover both standard and custom-fitted lymphedema compression treatment items for each affected body part. This comprehensive coverage includes:
Compression garments for daytime and nighttime use, featuring varying levels of compression.
Compression bandaging systems and supplies utilized during the initial decongestion and maintenance phases of treatment.
Gradient compression wraps equipped with adjustable straps.
Essential accessories for gradient compression garments and wraps, such as aids for donning and doffing, fillers, lining, padding, and zippers.
Frequency of Coverage
Medicare will reimburse beneficiaries for compression garments based on the following schedule:
Daytime: 3 garments per affected body part every 6 months.
Nighttime: 2 garments per affected body part every 2 years.
Additionally, coverage is available for items as needed, including replacements for lost, stolen, or irreparably damaged items and adjustments due to changes in the patient's condition, such as alterations in limb size.
Medicare will cover these treatment items if the following conditions are met:
The patient has Medicare Part B coverage (subject to the annual Part B deductible and 20% coinsurance).
The patient is diagnosed with lymphedema, and the item is prescribed by an authorized practitioner for primary and customary treatment.
To furnish these treatment items, individuals must be enrolled DMEPOS (Durable Medical Equipment, Prosthetics, Orthotics, and Supplies) suppliers. For those enrolling in Medicare for the first time to supply lymphedema compression treatment items, submitting a letter with the application is necessary, and CMS 855S is being updated to include these items.
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