Lymphedema Compression Treatment Items

Medicare pays for lymphedema compression treatment items. The items and services included in this benefit category are defined in section 1861(s)(2)(JJ) of the Social Security Act (the Act), and further defined in Medicare regulations at 42 Code of Federal Regulations (CFR) 410.36(a)(4).

The benefit includes medically necessary treatment items for each affected body part, including:

• Standard and custom fitted, gradient 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

Medicare pays for both standard and custom fitted gradient compression garments. Custom fitted compression garments are garments that are 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. This is defined in section 145 of chapter 15 of the Medicare Benefit Policy Manual (CMS Pub. 100-2).

Certain laws, regulations, and Medicare program manuals are often mentioned on this page, and you can locate them by going to the “Related Links” section.

Question:

Are there any limits to how many lymphedema compression treatment garments an individual with Medicare can get?

Answer:

Medicare pays for compression garments as follows:

• 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

Replacement and frequency limitations are described in section 145 of chapter 15 of the Medicare Benefit Policy Manual (CMS Pub. 100-2).

Question:

Who can furnish lymphedema compression treatment items to people with Medicare?

Answer:

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

Question:

Should therapists bill Medicare for time educating patients on donning/doffing garments after the garment has been delivered by the DMEPOS supplier?

Answer:

Payment for the cost of all services associated with furnishing gradient compression garments for treatment of lymphedema ─ including the education of donning and doffing the garment ─ is included as part of the bundled payment made to the DMEPOS supplier. For this reason, CMS cannot additionally pay for such training/education separately under the physician fee schedule (PFS). View a complete list of the services covered via the bundled payment.

Question:

When is it appropriate for a therapist to order bandages, assuming the DMEPOS supplier is providing the compression garment? Can they be ordered before and after the garment is purchased through the DMEPOS supplier?

Answer:

Bandages would be furnished if ordered by the physician and the DME Medicare Administrative Contractor would pay for the garments and/or bandaging if determined to be reasonable and necessary for the individual. As mandated by section 1861(mmm)(3) of the Act, items covered under the Medicare Part B benefit for lymphedema compression treatment items must be prescribed by a physician (or a physician assistant, nurse practitioner, or clinical nurse specialist (as those terms are defined in section 1861(aa)(5) of the Act) to the extent authorized under State law.