Lymphedema Treatment Act
What is the Lymphedema Treatment Act?
The Lymphedema Treatment Act is a federal law passed on December 23, 2022, to improve Medicare insurance coverage for the medically necessary, doctor-prescribed compression supplies that are the cornerstone of lymphedema treatment.
What you need to know about the Lymphedema Treatment Act?
The Lymphedema Treatment Act (LTA) will provide Medicare coverage for the diagnosis of Lymphedema by amending the Medicare statute to allow for coverage of compression supplies. The Lymphedema Treatment Act will amend Sec. 1861 [42 U.S.C. 1395x] of the Social Security Act to enable coverage of these items under Durable Medical Equipment.
The main highlights of the passing of this bill will be to:
• Improve insurance coverage for prescribed medical compression supplies.
• Reduce total healthcare costs with lymphedema.
When does the LTA go into effect?
January 1, 2024
As this is a new process, and claims filed with the DME MACs (Durable Medical Equipment Medicare Administrative Contractors) will be on a manual review process until all policies are in place which could be well into 2024. We expect updates to occur periodically.
Who is impacted by LTA and how?
The intention of the bill is to provide patients who are diagnosed with lymphedema access to the proper tools to treat this debilitating disease. The LTA will provide benefit coverage for compression therapy products for use in the decongestive and maintenance phases of treatment.
Please see our full library of educational and application videos at: JCI from Essity - Videos from JOBST Compression Institute
This content is for patients with Medicare.
If you’re a person with Medicare, learn more about your Medicare coverage for lymphedema compression treatment items.
Starting January 1, 2024, Medicare will pay for lymphedema compression treatment items for Medicare Part B patients.
This content is for health care providers and dealers.
To view a list of JOBST compression products and its CMS Suggested HCPCS Codes, click here.
To read about what’s covered under CMS guidelines, click here: Lymphedema Compression Treatment Items | CMS
Please note: A HCPCS Code (Healthcare Common Procedure Coding System Codes) is never a guarantee of coverage or payment for any claim submitted for payment to any private and public insurance carrier.
If you need further information reach out to your JOBST sales representative or visit https://www.cms.gov/medicare/payment/fee-schedules/dmepos-fee-schedule/lymphedema-compression-treatment-items.
The Centers for Medicare & Medicaid Services (CMS) uses Palmetto GBA as the Pricing, Data Analysis, and Coding (PDAC) Contractor. The PDAC Contractor maintains the Product Classification List, located at https://www4.palmettogba.com/pdac_dmecs. The Product Classification List is a searchable database containing products that have received HCPCS coding verification from PDAC and their corresponding HCPCS codes. BSN Medical Inc., however, makes no representations as to the accuracy of the information contained within the PDAC database, nor any representations as to whether its products are reimbursable under any government sponsored healthcare program and/or private-insurance program. It is the provider’s sole responsibility, in consultation with the insurer, if necessary, to determine medical necessity, ensure coverage criteria is met, and submit appropriate codes, modifiers, and charges for services rendered. RV: 12/23
