Below is a summary of the Medicare coverage that began on January 1, 2024, thanks to passage of the Lymphedema Treatment Act.Note that these coverage details are specific to traditional Medicare.
If you receive a denial please use our Denial Reporting Form. It is important that we hear from anyone who is not receiving coverage so we can address any remaining coverage issues.
TRADITIONAL MEDICARE COVERAGE SUMMARY
What will be covered:
Custom and standard fit daytime and nighttime garments.
Custom and standard fit daytime and nighttime garments.
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.
Deductibles and copay:
These supplies will be covered under Part B, so the annual Part B deductible and 20% coinsurance apply to all compression supplies.
