Lymphedema Insurance Coverage Updates & Resources

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.

To help suppliers, CGS and Noridian Provider Outreach and Education worked together to answer the most frequently asked questions. View the FAQs published by CGS and those by Noridian.

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.

 This publication provides billing and coding guidance pertinent to lymphedema compression treatment items, based on the CMS Final Rule CMS-1780-F. Read the article. Use this helpful online tool to look up the fee schedule based on HCPCS code.  

• Jurisdiction A: CT, DE, MA, ME, MD, NH, NJ, NY, PA, RI, VT, Washington D.C.
• Jurisdiction B: IL, IN, KY, MI, MN, OH, and WI
• Jurisdiction C: AL, AR, CO, FL, GA, LA, MS, NM, NC, OK, PR, SC, TN, TX, VI, VA, and WV
• Jurisdiction D:  Am. Samoa, Guam, N. Mariana Is., AK, AZ, CA, HI, ID, IA, KS, MO, MT, NE, NV, ND, OR, SD, UT, WA, WY