Lymphedema Treatment Act
Sigvaris is happy to support lymphedema patient access to the compression products that they need! In that spirit, we are happy to provide a summary of the public information surrounding the implementation of the Lymphedema Treatment Act (LTA). Please know that we are not reimbursement consultants though. You should contact Medicare for more information or if you have questions about Medicare coverage for lymphedema compression products.
Starting January 1, 2024, Medicare will pay for lymphedema compression treatment items for Medicare Part B patients.
Medicare will pay for standard and custom-fitted lymphedema compression treatment items for each affected body part, including:
- Compression garments, including those for daytime and nighttime, which offer different levels of compression
- Compression bandaging systems and supplies provided during the initial decongestion phase and maintenance phases of treatment
- Gradient compression wraps with adjustable straps
- Necessary accessories for gradient compression garments and wraps, including:
- Aids for putting on and taking off (donning and doffing) items for different body parts, like lower limb butlers or foot slippers that help patients put on compression stockings, Fillers, Lining, Padding and Zippers
Medicare will pay for multiple compression treatment items:
- Daytime: 3 garments per affected body part every 6 months
- Nighttime: 2 garments per affected body part every 2 years
- To replace lost, stolen, or damaged products or if the patient’s condition changes
Patients must have Medicare Part B coverage, a lymphedema diagnosis and a prescription from their provider.
Information for suppliers:
- What is the Lymphedema Treatment Act (LTA)?
- The LTA is a federal law, effective January 2024, that expands medicare coverage to include vital medical graduated compression garments for the treatment of lymphedema.
View the final rule HERE
- Will products be sold in pairs or singles?
- The HCPCS are labeled as "each" so they must be billed as individual units
- What is covered?
- Lymphedema compression garments for Medicare Part B patients. Read more HERE
- Where can I find the fee schedule?
- You can view the fee schedule HERE.
- Do I have to be DMEPOS enrolled to bill Medicare?
- Yes
- How do I enroll for DMEPOS?
- Enroll HERE
- How do I bill a Medicare patient?
- Please contact the DME MAC in your geographical jurisdiction. Start HERE.
- How will this impact Medicare Advantage coverage?
- Medicare Advantage plans must cover all medically necessary services that Original Medicare covers. In many cases you may need to get approval from your plan before it covers certain services or supplies. Contact your specific plan if you have questions about covered services.
- How will this impact other commercial insurance plan coverage?
- Commercial plan providers can choose to follow Medicare guidelines or not. Contact the specific plan if you have questions about covered services.
- Are only medical devices covered?
- Yes, only Lymphedema Compression Treatment items that are Medical Devices are covered. No non-medical devices will be covered. Medicare indicated that Medical Devices at a minimum are registered with the FDA (Food and Drug Administration).
- Is Sigvaris registered with the FDA?
- Yes, Sigvaris is registered with the FDA.
Information for lymphedema patients:
- What is the Lymphedema Treatment Act (LTA)?
- The LTA is a federal law, effective January 2024, that expands medicare coverage to include vital medical graduated compression garments for the treatment of lymphedema.
- View the final rule HERE
- Where do I find DMEPOS enrolled suppliers?
- You can search for suppliers HERE.
- What is covered?
- Lymphedema compression garments for Medicare Part B patients. Read more HERE
- How will this impact Medicare Advantage coverage?
- Medicare Advantage plans must cover all medically necessary services that Original Medicare covers. In many cases you may need to get approval from your plan before it covers certain services or supplies. Contact your specific plan if you have questions about covered services.
- How will this impact other commercial insurance plan coverage?
- Commercial plan providers can choose to follow Medicare guidelines or not. Contact the specific plan if you have questions about covered services.
Resources
Acronyms
Meaning
Centers for Medicare & Medicaid Services
About
CMS is the federal agency that provides health coverage to more than 160 million through Medicare, Medicaid, the Children's Health Insurance Program, and the Health Insurance Marketplace. CMS works in partnership with the entire health care community to improve quality, equity and outcomes in the health care system.
Meaning
Durable Medical Equipment, Prosthetics/Orthotics, and Supplies
About
Healthcare equipment provided to patients
Meaning
Durable Medical Equipment Medicare Administrative Contractor
About
A Medicare Administrative Contractor (MAC) is a private health care insurer that has been awarded a geographic
jurisdiction to process Medicare Part A and Part B (A/B) medical claims or Durable Medical Equipment (DME) claims for Medicare Fee-For-Service (FFS) beneficiaries. CMS relies on a network of MACs to serve as the primary operational contact between the Medicare FFS program and the health care providers enrolled in the program. MACs are multistate, regional contractors responsible for administering both Medicare Part A and Medicare Part B claims
Meaning:
Healthcare Common Procedure Coding System
About:
A collection of standardized codes that represent medical procedures, supplies, products and services. The codes are used to facilitate the processing of health insurance claims by Medicare and other insurers.
Sigvaris is providing this public information as a resource for suppliers, clinicians, and patients with interest in the Lymphedema Treatment Act.
Sigvaris is not a reimbursement consultant or legal advisor. Please contact CMS directly to obtain specific information about the implementation of the Lymphedema Treatment Act.