My name is Sarah Bramblette. I’m the Board Chair of the Lymphedema Advocacy Group. This year, I’m thankful that the Lymphedema Treatment Act was passed and that, starting January 1 of 2024, Medicare will cover lymphedema compression garments!
I’ve been a Medicare beneficiary since 2013, and during that time my lymphedema has been more difficult to manage due to not having adequate compression. I’ve also experienced more frequent episodes of cellulitis.
I look forward to being able to once again properly manage my lymphedema, and for the first time, treat the lymphedema in my arms, as even when I had private insurance through my previous employer, I never had adequate coverage to cover both my legs and my arms. Thanks to the work of the Lymphedema Advocacy Group, not only will Medicare begin covering compression garments and supplies, they will calculate the allowable quantities based on the number of affected body areas, so that patients like me are able to get the quantities they need.
I am also thankful for the members of Congress who passed the bill, the organizations that helped with the implementation of the coverage, and especially for the advocates who reached out to their members of Congress and who submitted public comments to CMS. We’ve accomplished amazing things together, but our work is not done!
Please consider making a donation today, during this holiday weekend, or on Giving Tuesday, to support our continued efforts to ensure that all patients have the insurance coverage they need to effectively manage their lymphedema and lead full lives. You can make a donation online or by mailing a check.
Thank you so much for your support and Happy Thanksgiving!
Sincerely,
Sarah M. Bramblette, MSHL
Board Chair, Lymphedema Advocacy Group
Below is a summary of the LTA final rule. You can read the full 65 pages here. We have also inserted notes into our group’s public comment document, which can be read here, to indicate which of our comments were incorporated into the final rule.
The final rule is a huge victory for patients, but our work is not done yet. Please visit our Take Action page if you have any insurance plan other than traditional Medicare and haven’t contacted your own insurance provider yet.
Lymphedema Treatment Act Final Rule Coverage Summary
What will be covered:
- Custom and standard fit daytime and nighttime garments.
- Custom and standard fit gradient compression wraps with adjustable straps.
- Bandaging supplies for any phase of treatment.
- Accessories including but not limited to donning and doffing aids, padding, fillers, linings, and zippers.
Frequency allowances:
- Daytime garments – 3 sets (one garment for each affected body part) every six months, standard or custom fit, or a combination of both
- Nighttime garments – 2 sets (one garment for each affected body part) every two years, standard or custom fit, or a combination of both
- Bandaging supplies – no set limit in the rule.
- Accessories – no set limit, will be determined on a case-by-case basis depending on the needs of the patient.
Coverage requirements:
- To be eligible for the above coverage, a patient must have been diagnosed with lymphedema and have a prescription for the compression supplies.
- The coverage will begin January 1, 2024. There will be no retroactive coverage, meaning, you cannot submit claims for any garments or supplies purchased or ordered before 1/1/2024.
Codes and reimbursement rates:
- Starting next year, there will be 81 HCPSC codes specifically for lymphedema compression supplies, most of which are new, and the rule also outlines the process for the creation of additional codes in the future if needed.
- The corresponding reimbursement rates for these codes will be released soon and are not included in the rule.
Deductibles and copay:
- For traditional Medicare — these supplies will be covered under Part B, so the annual Part B deductible and 20% coinsurance apply to all compression supplies.
- For Medicare Advantage and all other types of insurance — out-of-pocket costs will vary depending on the specific terms of your plan. It is likely that your compression supplies will be subject to the same copay and deductibles as supplies covered under the DMEPOS (Durable Medical Equipment, Prosthetic and Orthotic Supplies) section of your policy.
PLEASE NOTE: The final rule also outlines the process for making future changes to and/or additions to coverage if/when needed. This is very important, and ensures we will not be in the position of needing to get another law passed if adjustments to the coverage need to be made, or if new treatment supplies become available and need to be added to coverage.
Together, our advocacy made all of this possible!
Heather Ferguson
Founder & Executive Director
Lymphedema Advocacy Group
LymphedemaTreatmentAct.org
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