Patients, care providers, and compression suppliers should all check out the Center for Medicare and Medicaid Services’ new page, Lymphedema Compression Treatment Supplies! It contains guidance that complements the information below, as well as links to important resources, especially for prescribers and suppliers.
PATIENTS & CARE PROVIDERS:
Eventually, you will be able to search for suppliers who sell compression by using the Medicare Equipment and Suppliers online search tool. Typically, Medicare participating providers also take other types of insurance, so even if you are not a Medicare beneficiary, this will be a helpful tool. If you do not have a supplier physically located in your area, do not worry, there will be online options. Because we do not know how long it will take for this directory to be updated, our group is currently working on assembling a list of participating providers and will share that with you as soon as it’s available.
CURRENT & FUTURE SUPPLIERS:
- If you are a Medicare participating supplier or in the process of enrolling, please let us know, so that we can include you in the list of resources mentioned above that we will be assembling for patients. Make sure to tell us if you will be accepting Medicare claims “on assignment” as we will be including these details on our resources list.
- Suppliers should make sure they are following all state licensure laws with regard to this product as well as meeting all Supplier Standards found at 42 CFR 424.57. Compliance with these laws and requirements will determine your qualification to provide this product.
- If you or your place of business ARE already enrolled as a Medicare supplier, other than letting us know so that we can include you on our resources list for patients, there is nothing further you need to do at this time. Lymphedema compression supplies will be included on the updated 855S, which CMS expects to release around February 2024.
- If you or your place of business ARE NOT already enrolled as a Medicare supplier, and you would like to be able to begin selling compression garments and supplies and billing Medicare, please follow these instructions at CMS’s Supplier Enrollment page.
- If current or prospective suppliers have any questions, the following contact information was included in the proposed rule: “Medicare provider and supplier enrollment inquiries may contact CMS – Frank Whelan 410-786–1302.”
If you have not yet completed the below action item, it’s not too late!
The final rule is a huge victory for patients, but our work is not done yet. Please visit our Take Action page if you have any insurance plan other than traditional Medicare and haven’t contacted your own insurance provider yet.
Below is a summary of the LTA final rule. You can read the full 65 pages here. We have also inserted notes into our group’s public comment document, which can be read here, to indicate which of our comments were incorporated into the final rule.
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.
Together, our advocacy made all of this possible! If you are able to make a donation to support our continued work, we would be so grateful. Thank you!
Heather Ferguson
Founder & Executive Director
Lymphedema Advocacy Group
LymphedemaTreatmentAct.org
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