CMS Pub. 100-02, ch. 15, § 145

A. General

Coverage of lymphedema compression treatment items is available as of January 1, 2024

for treating beneficiaries with any diagnosis of lymphedema. The lymphedema

compression treatment items must be prescribed by a physician (or a physician assistant,

nurse practitioner, or a clinical nurse specialist (as those terms are defined in section

1861(aa)(5) of the Act) to the extent authorized under State law). Coverage of

lymphedema compression treatment items for any non-lymphedema diagnosis is not

allowed. The items must be furnished by an enrolled DMEPOS supplier. All suppliers,

including physical therapists and other practitioners furnishing bandaging systems must

be enrolled as a DMEPOS supplier to be paid under Medicare Part B for furnishing

lymphedema compression treatment items.

The following categories of lymphedema compression treatment items are covered

when determined to be reasonable and necessary for the treatment of lymphedema:

1. Standard daytime gradient compression garments

2. Custom daytime gradient compression garments

3. Nighttime gradient compression garments

4. Gradient compression wraps with adjustable straps

5. Accessories (e.g., zippers, linings, padding or fillers, etc.) necessary for

the effective use of a gradient compression garment or wrap

6. Compression bandaging supplies

7. Other items determined by CMS to be lymphedema compression

treatment items under the benefit category determination process

established under 42 CFR § 414.1670. These procedures consider public

consultation via public meetings and in writing for new lymphedema

compression treatment items.

With respect to lymphedema compression treatment items:

1. Custom fitted gradient compression garment means a garment that is uniquely

sized and shaped to fit the exact dimensions of the affected extremity or part of

the body, of an individual to provide accurate gradient compression to treat

lymphedema.

2. Gradient compression means the ability to apply a higher level of compression or

pressure to the distal (farther) end of the limb or body part affected by

lymphedema with lower, decreasing compression or pressure at the proximal (closer) end

of the limb or body part affected by lymphedema.

B. Replacements and Frequency Limitations

Payment for replacement of lymphedema compression treatment items can be made for

garments or wraps that are lost, stolen, or 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 the new garment or wrap.

Except for replacements of lymphedema compression treatment items addressed above,

no payment may be made for gradient compression garments or wraps with adjustable

straps furnished other than at the following frequencies:

(1) Three units of daytime gradient compression garments or wraps with

adjustable straps per affected extremity or part of the body once every 6

months.

(2) Two garments for nighttime use per affected extremity or part of the body

once every two years.

There are no set frequency limitations for compression bandaging supplies. The DME

MACs have discretion to determine the replacement and frequency of compression

bandaging supplies that are reasonable and necessary.