Insurance coverage for patients needing medical compression for lymphedema, as outlined in the Lymphedema Treatment Act (LTA), began on January 1, 2024. Bras and Honey will continue to research the new Lymphedema Treatment Act (LTA) so we can try to educate patients and medical professionals about the legislation. Here are some frequently asked questions regarding Medicare lymphedema coverage.

What is the Lymphedema Treatment Act?
The LTA is a significant piece of legislation aimed at assisting patients with lymphedema. Passed by Congress in December 2022, its purpose is to establish a new Medicare benefit category to cover medical compression treatment garments and accessories for managing lymphedema. Coverage started on January 1, 2024.

What types of lymphedema compression items are covered?
According to Medicare, the following items are covered for patients diagnosed with lymphedema, evaluated on a case-by-case basis:

Custom and standard compression garments, including daytime, wraps, and nighttime products
Bandages used during treatment phases (decongestive and/or maintenance)
Accessories such as donning and doffing aids, padding, fillers, linings, and zippers
For more information, visit Medicare.

How many garments are covered by CMS?
The Centers for Medicare and Medicaid Services (CMS) have specified the following coverage frequency:

Daytime: Three products (per affected body part) every six months
Nighttime: Two products (per affected body part) every two years
Bandages: Based on need
Accessories: Based on need
What if I damage or lose my garment, or if it no longer fits?
CMS will replace your garment if it is lost, stolen, or irreparably damaged. If your condition (e.g., limb size) changes, CMS will also replace your garment with proper documentation from a medical professional.

What type of insurance coverage is available for lymphedema garments?
To qualify for coverage, you must have a lymphedema diagnosis, a prescription, and additional documentation for compression products. There is no retroactive coverage for items purchased before January 1, 2024. For traditional Medicare, compression garments and supplies are covered under Part B, meaning the annual Part B deductible and 20% coinsurance apply. For Medicare Advantage and other insurance types, out-of-pocket costs will vary depending on the specific terms of your plan.

Talk with the Bras and Honey team to get properly fitted for medical compression garments and find out what may work best for you. They also can help you understand the new insurance coverage available.

Please note that the compression specialists at Bras and Honey in San Diego are not medical professionals and can only provide guidance on the fit of compression garments. For a more comprehensive assessment, a fitter, doctor, or therapist can offer detailed insights and compare multiple brands to find the garment that will help you achieve optimal results.