Insurance coverage for patients in need of medical compression to help manage lymphedema outlined in the Lymphedema Treatment Act (LTA) went into effect Jan. 1, 2024. Juzo has been working with Reimbursement Consultant Carmen Anderson to help patients, medical professionals and authorized Juzo dealers better understand the legislation. She answers some commonly asked questions below.
What is the Lymphedema Treatment Act?
The LTA is a pivotal piece of legislation to help patients impacted by lymphedema. Congress passed it in December 2022. The goal of the legislation was to create a new Medicare benefit category to provide insurance coverage for medical compression treatment garments and accessories to help manage lymphedema. Coverage went into effect Jan. 1, 2024.
What types of lymphedema compression items are covered?
Per Medicare, insurance coverage for the following items will be available for patients diagnosed with lymphedema—on an individual, claim-by-claim basis:
- Custom and standard compression garments, including daytime, wraps and nighttime products
- Bandages used during treatment phases (decongestive and/or maintenance)
- Accessories, including, but not limited to, donning and doffing aids, padding, fillers, linings, and zippers
Find out more from Medicare
How many garments are covered by CMS?
The Centers for Medicare and Medicaid Services (CMS) have determined the following frequency allowance for patients:
- Daytime: three products (for each affected body part) every six months
- Nighttime: two products (for each affected body part) every two years
- Bandages: based on need
- Accessories: based on need
What happens 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 (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 be eligible for coverage, you must have a lymphedema diagnosis and prescription for compression products. There is no retroactive coverage for products purchased prior to Jan. 1, 2024. For traditional Medicare, compression garments and supplies will be covered under Part B, so the annual Part B deductible and 20% coinsurance apply to all compression supplies. For Medicare Advantage and all other types of insurance, out-of-pocket costs will vary depending on the specific terms of your plan.
Was Juzo involved in shaping lymphedema coverage?
While Juzo was not involved in drafting the legislation, key representatives from Juzo have helped inform CMS on lymphedema and the benefits of medical compression to advocate for adequate coverage. Also, Juzo is part of the United States Medical Compression Alliance (USMCA), composed of prominent compression garment manufacturers, that has worked with industry leaders, advocacy groups and clinical organizations over the last year to help ensure patients have optimal access to medically necessary compression products. Juzo will continue to those who prescribe and provide medical compression garments to patients navigate the new insurance coverage and reimbursement process through advocacy, education and other efforts.
Talk with your authorized Juzo dealer and care 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.
Follow us on Instagram, @JuzoCompression, and Facebook to learn more about Juzo products, programs and ways we support the lymphedema community.