L&R USA has long advocated for improved patient access to compression garments and bandaging supplies. As a founding sponsor of the Lymphedema Advocacy Group (LAG), we have actively supported the bill since introduction in 2010. In addition, Lindsay Ryback, our North American Marketing Manager - Compression, has been serving on the LAG board since 2016.
Photos above from the celebration of the Lymphedema Treatment Act passage in 2024 at Capitol Hill in Washington DC.
In 2022, L&R USA stepped up our efforts by becoming a member of the US Medical Compression Alliance (USMCA) - a coalition of medical compression device manufacturers. The USMCA mission is to promote awareness of, and access to, medically necessary medical compression garments and bandaging supplies for lymphatic and venous diseases. L&R is a USMCA Class A Member and Lindsay Ryback currently holds the USMCA 2024 board role as Secretary. We are excited to help the USMCA fulfill it’s mission to support patients and providers across the United States.
As the LTA passed into federal law on 12/23/22, L&R USA dedicated a substantial amount of time, effort and resources to specifically promote the fair coverage of compression for daytime & nighttime use, including adjustable wraps, accessory (efficacy) aids, and bandaging products.
Some of the positive outcomes include:
Bandaging
- The inclusion of coverage for bandages during both phases of lymphedema treatment, decongestion and maintenance, instead of decongestion only.
- The creation of 16 new bandaging codes specific for lymphedema.
Nighttime
- The allowance of two nighttime products every two years, as opposed to the initially-proposed rule of every five years.
- The creation of 10 new nighttime codes, when there were previously none.
- No assignment of mmHg ranges to nighttime products, allowing clinician discretion for dosage.
Daytime
- The allowance of three daytime products every 6 months, including adjustable wraps, per affected body part, instead of the initially-proposed quantity of two.
- The creation of 50 new daytime codes (including 43 general daytime garments and seven adjustable wraps) specific for lymphedema.
L&R continues to lead advocacy efforts for a more inclusive and supportive environment for nighttime, adjustable wrap, daytime, accessory (efficacy) aids, and bandaging products. We will target the current and evolving needs of patients, providers, and suppliers to support successful outcomes. Join us in celebrating these key wins and stay informed about our ongoing endeavors by signing up for our newsletter.
Read on to learn more about the implementation of the Lymphedema Treatment Act and find the answers to frequently asked questions.
What
The Lymphedema Treatment Act is a federal law passed on December 23, 2022 to implement insurance coverage for lymphedema treatment. It focuses on providing necessary medical equipment and supplies, such as compression garments for daytime & nighttime and bandages, to patients with a lymphedema diagnosis.
When
Coverage went into effect January 1, 2024. In the absence of a medical policy, claims submitted to the Durable Medical Equipment Medicare Administrative Contractors (DME MACs) will be reviewed on a claim-by-claim basis.
Who
Patients with the following ICD-10 codes are eligible for coverage:
| ICD-10 Code | Description |
| I89.0 | Lymphedema, not elsewhere classified |
| Q82.0 | Hereditary Lymphedema |
| I97.2 | Postmastectomy Lymphedema Syndrome |
| I97.89 | Other postprocedural complications and disorders of the circulatory system, not elsewhere classified |
How
Policies related to coverage for lymphedema treatment may evolve, and providers should stay informed about any updates or changes issued by the DME MACs or CMS. Most recently, the DME MACs released a joint publication for correct coding and billing: Lymphedema Compression Treatment Item - Correct Coding and Billing - Revised (PDF).
L&R has many products eligible for coverage, please contact inquiries@us.LRmed.com to request more information.
When was the final rule released?
On November 3, 2023, CMS released its final rule regarding implementing the Lymphedema Treatment Act, which outlines how CMS will begin covering compression garments and related accessories for patients diagnosed with lymphedema.
Where can I read the final rule?
Click here (PDF). Page 350 is start of the primary section pertaining to lymphedema.
When will this new benefit coverage begin?
Coverage went into effect January 1, 2024. There will not be retroactive coverage for items billed before January 1, 2024.
Will phlebolymphedema and/or lipedema be covered?
CMS has stated the scope of the new benefit for lymphedema compression treatment items is only available to individuals with a diagnosis of lymphedema with IC-10 codes (I89.0, Q82.0, I97.2, I97.89).
Where can I find general coverage information released by Medicare?
Click here for the CMS “Lymphedema Compression Treatment Items” summary and click here (PDF) for the Medicare Learning Network implementation article.
How will this impact Medicare Advantage coverage?
Medicare Advantage Plans must cover all the essential services that Original Medicare covers. In some cases, you may need to get permission from your plan before it covers certain services or supplies. If you are unsure about the services covered, contact the specific plan.
How will this impact other commercial insurance plan coverage?
Commercial plans have the choice to use the policies and guidelines that Medicare publishes or create their own versions. For information about the services covered by commercial plans, contact the specific plan.
Will the HCPCS change for commercial insurance?
HCPCS are generally adopted as a standard by most payers. However, commercial insurance plans might still use S-codes, which are invalid for Medicare.
Where can I find the fee schedule?
Click here to view the CMS page containing the DMEPOS fee schedule.
What will the fee schedule be for commercial insurance?
It depends. Please contact the claims and billing department for the specific payer.
Is Medicare paying a separate fitting fee?
No, DMEPOS suppliers are responsible for all aspects of furnishing the item, including fitting, and measuring services.
Are there any fitter certification or licensure requirements?
At this time, CMS does not require specific credentials for fitting.
Who is authorized to prescribe compression supplies?
Physician Assistants (PAs), Doctors of Osteopathic Medicine (DOs), Doctors of Medicine (MDs), or Nurse Practitioner (NPs) can write the prescription.
Will all brands of products be covered?
Medicare has not identified specific brands for coverage, but rather compression types including nighttime, daytime (garments and adjustable wraps), accessories (efficacy aids), and bandages.
What if products are sold in pairs?
The HCPCS codes label items as "each", indicating they must be billed as individual units.
Is DMEPOS enrollment required to bill Medicare?
Yes, CMS requires suppliers to be enrolled, accredited, and in compliance with the DMEPOS quality standards and supplier standards in order to be reimbursed for providing lymphedema products.
When is CMS going to update the DMEPOS enrollment process for lymphedema compression items and supplies?
Provider Enrollment, Chain, and Ownership System (PECOS) was updated on January 22, 2024, and the new 855S form will be issued to the public on March 17, 2024. Please note that the National Provider Enrollment (NPE) contractors will continue to accept the previous version of the CMS-855S until June 15, 2024. After that date, suppliers will be required to submit the new 855s form.
Where can I find the CMS DMEPOS quality standards and supplier standards?
CMS DMEPOS Quality Standards and CMS DMEPOS Supplier Standards*
*Please note the full text of the CMS DMEPOS Supplier Standards can be obtained via the Office of the Federal Register.
Where can I find more information on accreditation?
Please review the CMS DMEPOS Accreditation Fact Sheet.
BOC has also created a number of resources, available here: BOC Lymphedema/Compression resource page.
How do I bill Medicare?
A Durable Medical Equipment (DME) Medicare Administrative Contractor (MAC) is a private healthcare insurer with geographic jurisdiction to process DMEPOS claims for Medicare Fee-For-Service (FFS) beneficiaries. Contact the DME MAC in your area.
How do I bill other insurance plans or patients with insurance plans other than Medicare?
Contact the specific payer’s claims and billing department for more information.
Will lymphedema compression treatment items be placed in the Competitive Bidding Program?
CMS has not yet decided to include these items in the Competitive Bidding Program but has the authority to do so in the future.
Have a question not answered above?
Please reach out to us at marketing@us.LRmed.com and we will do our best to answer your additional questions.
The content on this page is for general informational purposes only. We strive to ensure information is up-to-date and accurate, but recommend readers do their due diligence to do additional research for you and/or your business. In addition, we have provided links to reliable sources for additional information, but L&R USA INC. does not manage those external resources and is not liable for the accuracy of the information presented there.