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LTA Coverage Rules and FAQs

As part of the process for implementing the Lymphedema Treatment Act, the Centers for Medicare and Medicaid Services (CMS) issued a final rule outlining the details of the coverage. A summary of the coverage can be found below and downloaded here.
Prior to issuing the final rule, CMS released a proposed coverage plan for lymphedema compression garments and supplies, after which a 60-day Public Comment Period was held. You can read our group’s comments as well as all of the 700+ comments.

Answers to frequently asked questions about the Lymphedema Treatment Act and related coverage can be found here.

Lymphedema Treatment Act Final Rule Coverage Summary

What will be covered:

  • Custom and standard fit daytime and nighttime garments.
  • Custom and standard fit gradient compression wraps with adjustable straps.
  • Bandaging supplies for any phase of treatment.
  • Accessories including but not limited to donning and doffing aids, padding, fillers, linings, and zippers.

Frequency allowances:

  • Daytime garments – 3 sets (one garment for each affected body part) every six months, standard or custom fit, or a combination of both
  • Nighttime garments – 2 sets (one garment for each affected body part) every two years, standard or custom fit, or a combination of both
  • Bandaging supplies – no set limit in the rule.
  • Accessories – no set limit, will be determined on a case-by-case basis depending on the needs of the patient.

Coverage requirements:

  • To be eligible for the above coverage, a patient must have been diagnosed with lymphedema and have a prescription for the compression supplies.
  • The coverage will begin January 1, 2024. There will be no retroactive coverage, meaning, you cannot submit claims for any garments or supplies purchased or ordered before 1/1/2024.

Codes and reimbursement rates:

  • Starting next year, there will be 81 HCPSC codes specifically for lymphedema compression supplies, most of which are new, and the rule also outlines the process for the creation of additional codes in the future if needed.
  • The corresponding reimbursement rates for these codes will be released soon and are not included in the rule.

Deductibles and copay:

  • For traditional Medicare — these supplies will be covered under Part B, so the annual Part B deductible and 20% coinsurance apply to all compression supplies.
  • For Medicare Advantage and all other types of insurance — out-of-pocket costs will vary depending on the specific terms of your plan. It is likely that your compression supplies will be subject to the same copay and deductibles as supplies covered under the DMEPOS (Durable Medical Equipment, Prosthetic and Orthotic Supplies) section of your policy.
PLEASE NOTE: The final rule also outlines the process for making future changes to and/or additions to coverage if/when needed. This is very important, and ensures we will not be in the position of needing to get another law passed if adjustments to the coverage need to be made, or if new treatment supplies become available and need to be added to coverage.

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