Lymphedema Compression Treatment Items

Starting January 1, 2024, Medicare will pay for lymphedema compression treatment items for Medicare Part B patients.

What’s Covered?

We’ll pay for standard and custom-fitted lymphedema compression treatment items for each affected body part, including:

• Compression garments, including those for daytime and nighttime, which offer different levels of compression
• Compression bandaging systems and supplies provided during the initial decongestion phase and maintenance phases of treatment
• Gradient compression wraps with adjustable straps
• Necessary accessories for gradient compression garments and wraps, including:
  • Aids for putting on and taking off (donning and doffing) items for different body parts, like lower limb butlers or foot slippers that help patients put on compression stockings
  • Fillers
  • Lining
  • Padding
  • Zippers

How Often?

We pay for compression garments:

• Daytime: 3 garments per affected body part every 6 months
• Nighttime: 2 garments per affected body part every 2 years

We also pay for items, as needed:

• To replace lost, stolen, or irreparably damaged items
• If a patient’s condition changes, like a change in limb size

Who’s Eligible?

We’ll pay for these treatment items when:

• The patient has Medicare Part B coverage (their annual Part B deductible and 20% coinsurance will apply)
• The patient has lymphedema (a chronic condition that causes swelling in the body's tissues) and will use the item to primarily and customarily treat it
• An authorized practitioner prescribes the item

Can I Furnish These Items?

You must be an enrolled DMEPOS supplier to get Medicare payment for furnishing these treatment items. Become a DMEPOS supplier.

If you’re enrolling in Medicare for the first time to supply lymphedema compression treatment items, submit a letter stating this with your application. We’re working on updating the CMS 855S to include these items.

What Are My Responsibilities?

When you furnish a lymphedema compression treatment item, you’re responsible for all aspects of providing the item, unless you work out an arrangement with an external fitter to perform the services. This includes:

• Taking measurements of the patient’s affected body area
• Performing necessary fitting services
• Training the patient how to take the treatment item on and off
• Showing the patient how to take care of the treatment item
• Adjusting the treatment item, if needed

How Can I Bill?

Starting January 1, use new and existing codes in the January 2024 Alpha Numeric HCPCS File. 

For more information on billing, view MLN Matters: Lymphedema Compression Treatment Items: Implementation (PDF).

Where Can I Get More Information?

• Final Rule
• Section 4133 of the Consolidated Appropriations Act (CAA)
• Section 1834(j) of the Act
• Medicare Benefit Policy Manual, Chapter 15 (PDF):
  • Section 110.8: DMEPOS benefit category determinations
  • Section 145: covered items, replacements, and frequency limitations
• Medicare Claims Processing Manual, Chapter 20 (PDF):
  • Section 181.1: payment policy