What the New Lipedema Diagnosis
Code Could Mean for Coverage
By Sarah Bramblette
Throughout my years advocating for the Lymphedema Treatment Act, one question came up time and time again:
“What about lipedema?”
As someone living with both lipedema and lymphedema, I understood the frustration. Lipedema is often confused with lymphedema, many patients live with both conditions and too often people living with lipedema have felt left behind.
My answer was always the same: we need a diagnosis code first.
Lipedema did not have its own ICD-10 diagnosis code, and in healthcare, treatments and supplies are tied to diagnosis codes. Without one, lipedema couldn’t be included in the Medicare payment category for compression supplies created by the Lymphedema Treatment Act.
Fortunately, the Lymphedema Treatment Act included language allowing the Secretary of Health and Human Services to modify covered diagnoses in the future. Now, with a dedicated ICD-10 diagnosis code for lipedema scheduled to take effect in October 2027, the work can begin to advocate for adding lipedema to the diagnoses eligible for compression supply coverage.
Today, patients who have both lipedema and secondary lymphedema may qualify for compression supplies because their lymphedema diagnosis is covered. However, many people living with lipedema do not have a secondary diagnosis of lymphedema. For those patients, having a dedicated diagnosis code is an important first step toward improving access to care.
The new diagnosis code may also help support future advocacy for coverage of other medically necessary treatments, including compression pumps, manual lymphatic drainage, therapy and surgery.
Will these treatments automatically become covered once the diagnosis code takes effect? No. We spent more than a decade advocating for the Lymphedema Treatment Act, and lymphedema had an established diagnosis code throughout that process.
But this is an important milestone.
For the first time, we have the foundation needed to pursue broader coverage for lipedema treatments. There is still work ahead, but we’re one step closer to ensuring people living with lipedema have access to the care and treatment they need.
If you’d like to learn more, here are two presentations I’ve given at Fat Disorders Resource Society (FDRS) conferences:
- We did it! The Lymphedema Treatment Act Passed! What now? What’s next?
- Advocacy Forward: Where are we Going? How do we Get There?
If you have questions about the new lipedema ICD-10 diagnosis code,
please contact the American Lipedema Association.
