There has been a long-standing struggle for patients diagnosed with lymphedema to receive Medicare and other payer coverage for compression garments. The Lymphedema Treatment Act (LTA) passed by Congress in December 2022 now provides patients with the coverage they need to manage their chronic disease. Defined within the LTA, CMS was given approximately one year to draft policy rules in preparation for the bill’s implementation on January 1. CMS spent the last year writing coverage language that was compliant with the legislation, but also adhered to current Medicare program regulations. This CMS language, in MLN Matters Article MM13286, was published in November 2023, which resulted in the DME MACs drafting more detailed coverage, coding, and documentation language.
With CMS’ and the DME MACs’ publication of legislation and coverage rules, we are reminded of why this ruling was a necessity. Historically, these types of compression garments were only covered under the Surgical Dressing Benefit Category for Medicare. However, this coverage was limited and required the patient to have a wound (surgical or debrided), which rarely applied to lymphedema patients. This resulted in patients being financially responsible for any compression items required to treat their condition. This legislation forced CMS to create a new benefit category to facilitate coverage for these items for lymphedema patients, differentiating them from wound-care patients requiring compression items.
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