The USMCA works to ensure clinically appropriate, high quality, medical compression garments are available to Medicare recipients with a lymphedema diagnosis in compliance with the Lymphedema Treatment Act (LTA), which passed December 2022. The resources below provide the latest information regarding implementation of this coverage.
Stay informed of the latest updates around insurance coverage for lymphedema treatment items below and review our FAQs.
The CMS Healthcare Common Procedure Coding System (HCPCS) Level II coding, benefit category and payment determinations are effective, as of April 1, 2025. Noridian published a Joint DME MAC and PDAC Publication with the codes (lymphedema compression codes are in two sections, "Added Codes: Miscellaneous" and "Narrative Changes: Miscellaneous").
Read the CMS final decision publication (compression-specific details begin on page 185).
After reviewing the CMS publication that indicated 71 lymphedema codes would be bundled into home health payments, USMCA rallied stakeholders and educated CMS on the negative impact to patients. CMS rescinded that decision and issued a correction, Sept. 25. Lymphedema garments will continue to be reimbursable SEPARATELY for patients, including those receiving home health care.
The Noridian DME Outreach and Education team shares information for DME suppliers on policy information regarding Lymphedema Compression Treatment items.
Recorded Feb. 20, 2025
Reimbursement & Market Access Consultant Carmen Anderson provides updates on changes to Medicare coverage for lymphedema treatment items.
Recorded Feb. 14, 2025
Board of Certification/Accreditation (BOC) accredits DME businesses, allowing them to bill third-party payers, including CMS. BOC offers several helpful resources for DMEPOS accreditation.
USMCA compiled these resources to help navigate the implementation of the Lymphedema Treatment Act.
CGS Provider Outreach and Education developed this Fact Sheet to help you quickly understand the new Lymphedema Compressions Treatment Items benefit. Scroll to the bottom of that page to access additional resources.
The USMCA summarized the public information (published Jan. 22, 2024) regarding the LTA final rule with links to helpful resources. Access the article.
USMCA Consultant Carmen Anderson authored the article, "Medicare Coverage Expanded to Include Lymphedema Compression Supplies in 2024" for a recent AVF newsletter.
The Lymphedema Advocacy Group shared two webinars that provide a wealth of information for clinicians and suppliers. Linda Roherty, PT, CLT-LANA, and Guenter Klose hosted "LTA & Medicare Documentation Requirements Unpacked." SunMed Medical, with the National Lymphedema Network, led the "Putting the Pieces Together for Clinicians" webinar.
Centers for Medicare & Medicaid Services (CMS) outlines what's covered, how often, who is eligible and more. Visit the CMS site to learn more.
Noridian and CGS provide billing and coding guidance pertinent to lymphedema compression treatment items, based on the CMS Final Rule CMS-1780-F. Read the Noridian article. Access the CGS version. Use this helpful online tool to look up the fee schedule based on HCPCS code.
Information USMCA shares on this website is intended solely for general educational purposes—not as professional advice. Always seek advice of a qualified healthcare professional if you need a medical diagnosis or treatment, as it relates to topics discussed. Do not disregard advice you have received, nor delay getting such advice, because of something you learn on this website or in our videos. The identification of an organization or product in the information USMCA shares does not imply any form of endorsement.
Questions? Email contact@usmedicalcompressionalliance.org.
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