The new Lymphedema Compression Treatment Items Fact Sheet provides details on standard and custom-fitted compression garments and other lymphedema compression treatment supplies.
The new benefit, which started Jan. 1, covers standard and custom daytime and nighttime compression garments; gradient compression wraps; compression bandaging systems and supplies during phase 1 (initial) and phase 2 (maintenance) periods; accessories needed for compression treatment; donning/doffing aids; fillers; lining; padding; and zippers.
To qualify for Medicare coverage, beneficiaries must have one of the following ICD-10-CM codes: I89.0 (lymphedema, not elsewise classified); I97.2 (postmastectomy lymphedema syndrome); I97.89 (other postprocedural complications and disorders of the circulatory system, not elsewhere classified); Q82.0 hereditary lymphedema.
Under the new benefit, Medicare will allow and replace three daytime garments or wraps per body area once every six months; will cover two nighttime garments per body area once every two years; and will cover compression bandaging supplies and accessories when medically necessary to treat lymphedema.
Garments and wraps can be replaced if they are lost, stolen, or irreparably damaged in a specific incident; or when the patient experiences a change in medical or physical condition.
