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Lymphedema Compression Treatment Items

1 May 2024 8:07 AM | Zachary Edgar (Administrator)

Coverage

Coverage of lymphedema compression treatment items is available as of January 1, 2024 for treating beneficiaries with any diagnosis of lymphedema. The lymphedema compression treatment items must be prescribed by a physician (or a physician assistant, nurse practitioner, or a clinical nurse specialist. Coverage of lymphedema compression treatment items for any non-lymphedema diagnosis is not allowed. The items must be furnished by an enrolled DMEPOS supplier. All suppliers, including physical therapists and other practitioners furnishing bandaging systems must be enrolled as a DMEPOS supplier to be paid under Medicare Part B for furnishing lymphedema compression treatment items.

The following categories of lymphedema compression treatment items are covered when determined to be reasonable and necessary for the treatment of lymphedema:

  • Standard daytime gradient compression garments
  • Custom daytime gradient compression garments
  • Nighttime gradient compression garments
  • Gradient compression wraps with adjustable straps 
  • Accessories (e.g., zippers, linings, padding or fillers, etc.) necessary for the effective use of a gradient compression garment or wrap
  • Compression bandaging supplies
  • Other items determined by CMS to be lymphedema compression treatment items under the benefit category determination process. These procedures consider public consultation via public meetings and in writing for new lymphedema compression treatment items.

With respect to lymphedema compression treatment items:

  • Custom fitted gradient compression garment means a garment that is uniquely sized and shaped to fit the exact dimensions of the affected extremity or part of the body, of an individual to provide accurate gradient compression to treat lymphedema.
  • Gradient compression means the ability to apply a higher level of compression or pressure to the distal (farther) end of the limb or body part affected by lymphedema with lower, decreasing compression or pressure at the proximal (closer) end of the limb or body part affected by lymphedema.

Replacements and Frequency Limitations

Payment for replacement of lymphedema compression treatment items can be made for garments or wraps that are lost, stolen, or irreparably damaged. 

If a patient’s medical condition has changed enough to warrant the need for a new size or type of garment or wrap, payment can be made for the new garment or wrap. 

Except for replacements of lymphedema compression treatment items addressed above, no payment may be made for gradient compression garments or wraps with adjustable straps furnished other than at the following frequencies:

  • Three (3) units of daytime gradient compression garments or wraps with adjustable straps per affected extremity or part of the body once every six (6) months.
  •  Two (2) garments for nighttime use per affected extremity or part of the body once every two (2) years.

There are no set frequency limitations for compression bandaging supplies. The DME MACs have discretion to determine the replacement and frequency of compression bandaging supplies that are reasonable and necessary.

Reference

Medicare Benefit Manual.  Chapter 15 – Covered Medical and Other Health Services § 145

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