We wanted to send this clarification to assure you that the frequency limitations are based on sets of garments, not individual garments. We apologize that the initial quoted section below did not make that explicitly clear, but elsewhere in the final rule it states the following:
After consideration of the public comments received, we are finalizing §414.1680 with the following modifications to the frequency limitations for lymphedema compression items established in accordance with section 1834(z)(2) of the Act under new subpart Q:
Three daytime garments or wraps with adjustable straps for each affected limb or area of the body, replaced every 6 months.
Two nighttime garments for each affected limb or area of the body, replaced once every 2 years.
We are finalizing coverage of replacements of garments or wraps that are lost, stolen, irreparably damaged. If a patient’s medical condition has changed enough to warrant the need for a new size or type of garment or wrap, payment can be made for new garments or wraps.
Dear [CONTACT: first name],
The final rule for implementation of the Lymphedema Treatment Act was just released! The full rule contains a number of different provisions, but you can read the 65 pages related to compression coverage here.
We are still analyzing the final rule and will be back in touch again soon with a summary, but we didn’t want to wait to share this big news…
CMS has increased the frequency limitations from two sets of daytime compression garments every 6 months to three sets of daytime compression garments every 6 months! As stated in the final rule:
“We appreciate the comments in response to our request for input on our proposal for the frequency limitations for lymphedema compression treatment items and are finalizing changes based on that input. We are making the changes based on the concerns of the commenters related to multiple reasons for needing adequate time to wash and dry compression treatment items, and to be responsive to the needs of Medicare beneficiaries. Specifically, Medicare will cover and pay for three daytime garments or wraps every six months and two nighttime garments or wraps every 2 years. Three units of daytime garments or wraps allows the patient to wear one, wash one, and dry one. Also, Medicare will cover two nighttime garments or wraps every 2 years, allowing the beneficiary to wear one, while a second garment washed during the day is allowed to completely dry and be ready for use the following night.”
This is yet another example of the power of patient voices! It really does make a difference when you complete the advocacy actions that we share with you, and we are so grateful for everyone’s efforts.
So, once again, if you have any type of insurance other than traditional Medicare, it is very important that you complete the action item below if you have not yet done so.
This includes private insurance plans (whether employer-based or purchased separately), supplemental and secondary plans, Medicare Advantage, Medicaid, TriCare, and VA health care.
Use the following links to access the instructions and template language seen in the image below for contacting your insurance provider:
Please respond to this message if you have trouble accessing the information through the above links. Thank you for your advocacy!
Heather Ferguson
Founder & Executive Director
Lymphedema Advocacy Group
LymphedemaTreatmentAct.org
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