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Updated on Nov 27, 2023

Starting January 1, 2024, Medicare will extend its coverage to include lymphedema compression treatment items for Medicare Part B patients. This long-awaited change marks a significant advancement in the management and treatment of lymphedema, offering comprehensive support to those affected by this chronic condition. For details, see Medicare Final Rule, the CMS website and MLN Matters.

Coverage Details

Medicare will pay for standard and custom-fitted lymphedema compression treatment items for each affected body part, including: 

  • Compression Garments: Both standard and custom-fitted garments for daytime and nighttime use, offering varying compression levels.
  • Compression Bandaging Systems: Supplies for the initial and maintenance phases of lymphedema treatment.
  • Gradient Compression Wraps: These come with adjustable straps for a tailored fit.
  • Accessories: This encompasses items that aid in donning and doffing, fillers, linings, padding, and zippers.

How often does Medicare cover compression garments for lymphedema?

  • Daytime Garments: Eligible for 3 replacements every 6 months.
  • Nighttime Garments: Eligible for 2 replacements every 2 years.
  • Replacement items: are also covered when necessary due to a change in the patient’s condition or if items are lost, stolen, or irreparably damaged.

What are the eligibility criteria?

  • Patients with Medicare Part B coverage (subject to annual deductible and 20% coinsurance).
  • The patient has lymphedema and will use the item to primarily and customarily treat it
  • The items are prescribed by an authorized practitioner for the primary treatment of lymphedema.

Durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) supplier responsibilities

When you furnish a covered item for lymphedema compression treatment, you’re responsible for all aspects of providing the item, unless you work out an arrangement with a professional fitter to perform the services. This includes:

  • Taking measurements of the patient’s affected body area
  • Performing necessary fitting services
  • Training the patient how to take the treatment item on and off
  • Showing the patient how to take care of the treatment item
  • Adjusting the treatment item, if needed

How can suppliers bill?

Final New HCPCS Codes for Lymphedema Compression Treatment Items
  • A6610 Gradient compression stocking, below knee, 18-30 mmhg, custom, each
  • A6520 Gradient compression garment, glove, padded, for nighttime use, each
  • A6521 Gradient compression garment, glove, padded, for nighttime use, custom, each
  • A6522 Gradient compression garment, arm, padded, for nighttime use, each
  • A6523 Gradient compression garment, arm, padded, for nighttime use, custom, each
  • A6524 Gradient compression garment, lower leg and foot, padded, for nighttime use, each
  • A6525 Gradient compression garment, lower leg and foot, padded, for nighttime use, custom, each
  • A6526 Gradient compression garment, full leg and foot, padded, for nighttime use, each
  • A6527 Gradient compression garment, full leg and foot, padded, for nighttime use, custom, each
  • A6528 Gradient compression garment, bra, for nighttime use, each
  • A6529 Gradient compression garment, bra, for nighttime use, custom, each
  • A6552 Gradient compression stocking, below knee, 30-40 mmhg, each
  • A6553 Gradient compression stocking, below knee, 30-40 mmhg, custom, each
  • A6554 Gradient compression stocking, below knee, 40 mmhg or greater, each
  • A6555 Gradient compression stocking, below knee, 40 mmhg or greater, custom, each
  • A6556 Gradient compression stocking, thigh length, 18-30 mmhg, custom, each
  • A6557 Gradient compression stocking, thigh length, 30-40 mmhg, custom, each
  • A6558 Gradient compression stocking, thigh length, 40 mmhg or greater, custom, each
  • A6559 Gradient compression stocking, full length/chap style, 18-30 mmhg, custom, each
  • A6560 Gradient compression stocking, full length/chap style, 30-40 mmhg, custom, each
  • A6561 Gradient compression stocking, full length/chap style, 40 mmhg or greater, custom, each
  • A6562 Gradient compression stocking, waist length, 18-30 mmhg, custom, each
  • A6563 Gradient compression stocking, waist length, 30-40 mmhg, custom, each
  • A6564 Gradient compression stocking, waist length, 40 mmhg or greater, custom, each
  • A6565 Gradient compression gauntlet, custom, each
  • A6566 Gradient compression garment, neck/head, each
  • A6567 Gradient compression garment, neck/head, custom, each
  • A6568 Gradient compression garment, torso and shoulder, each
  • A6569 Gradient compression garment, torso/shoulder, custom, each
  • A6570 Gradient compression garment, genital region, each
  • A6571 Gradient compression garment, genital region, custom, each
  • A6572 Gradient compression garment, toe caps, each
  • A6573 Gradient compression garment, toe caps, custom, each
  • A6583 Gradient compression wrap with adjustable straps, below knee, 30-50 mmhg, each
  • A6584 Gradient compression wrap with adjustable straps, not otherwise specified
  • A6585 Gradient pressure wrap with adjustable straps, above knee, each
  • A6586 Gradient pressure wrap with adjustable straps, full leg, each
  • A6587 Gradient pressure wrap with adjustable straps, foot, each
  • A6588 Gradient pressure wrap with adjustable straps, arm, each
  • A6589 Gradient pressure wrap with adjustable straps, bra, each
  • A6593 Accessory for gradient compression garment or wrap with adjustable straps, non-otherwise specified
  • A6594 Gradient compression bandaging supply, bandage liner, lower extremity, any size or length, each
  • A6595 Gradient compression bandaging supply, bandage liner, upper extremity, any size or length, each
  • A6596 Gradient compression bandaging supply, conforming gauze, per linear yard, any width, each
  • A6597 Gradient compression bandage roll, elastic long stretch, linear yard, any width, each
  • A6598 Gradient compression bandage roll, elastic medium stretch, per linear yard, any width, each
  • A6599 Gradient compression bandage roll, inelastic short stretch, per linear yard, any width, each
  • A6600 Gradient compression bandaging supply, high density foam sheet, per 250 square centimeters, each
  • A6601 Gradient compression bandaging supply, high density foam pad, any size or shape, each
  • A6602 Gradient compression bandaging supply, high density foam roll for bandage, per linear yard, any width, each
  • A6603 Gradient compression bandaging supply, low density channel foam sheet, per 250 square centimeters, each
  • A6604 Gradient compression bandaging supply, low density flat foam sheet, per 250 square centimeters, each
  • A6605 Gradient compression bandaging supply, padded foam, per linear yard, any width, each
  • A6606 Gradient compression bandaging supply, padded textile, per linear yard, any width, each
  • A6607 Gradient compression bandaging supply, tubular protective absorption layer, per linear yard, any width, each
  • A6608 Gradient compression bandaging supply, tubular protective absorption padded layer, per linear yard, any width, each
  • A6609 Gradient compression bandaging supply, not otherwise specified
  • S8420 Gradient pressure aid (sleeve and glove combination), custom made
  • S8421 Gradient pressure aid (sleeve and glove combination), ready made
  • S8422 Gradient pressure aid (sleeve), custom made, medium weight
  • S8423 Gradient pressure aid (sleeve), custom made, heavy weight
  • S8424 Gradient pressure aid (sleeve), ready made
  • S8425 Gradient pressure aid (glove), custom made, medium weight
  • S8426 Gradient pressure aid (glove), custom made, heavy weight
  • S8427 Gradient pressure aid (glove), ready made
  • S8428 Gradient pressure aid (gauntlet), ready made
  • S8429 Gradient pressure exterior wrap
  • S8430 Padding for compression bandage, roll
  • S8431 Compression bandage, roll
  • Tips for billing

    • CMS will deny payment for claims for lymphedema treatment items that don’t have an appropriate diagnosis for lymphedema
    • Lymphedema compression treatment items for more than 1 body part or area per patient can be billed together
    • Both a daytime and nighttime garment for the same body part or area per patient can be billed together

    Learn more

    • Final Rule
    • Section 4133 of the Consolidated Appropriations Act (CAA)
    • Section 1834(j) of the Act

    This expansion of coverage is a significant step towards improving the quality of life for patients with lymphedema. As healthcare providers, let's prepare to implement these changes and enhance our care for those in need.

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