If you or a loved one has lymphedema, you may have heard about the LTA and wondered what it actually covers—and what you need to do to access those benefits. You’re not alone. This blog is designed to break it down in plain language so you can better advocate for your care.
What Is the Lymphedema Treatment Act?
The LTA is a federal law that requires Medicare to cover medically necessary compression garments and bandaging supplies for people diagnosed with lymphedema. Before this law, many patients had to pay out of pocket for essential supplies. This is a major step forward—but coverage depends on proper medical documentation.
Who Is Eligible for Coverage?
You may be eligible for coverage under the LTA if:
- You are a Medicare beneficiary, and
- You have a diagnosis of lymphedema documented by your healthcare provider
Your diagnosis must be listed using specific medical codes (called ICD-10 codes) that identify lymphedema.
What Does Medicare Cover?
Under the LTA, Medicare may cover:
- Compression garments (daytime and nighttime)
- Compression wraps
- Bandaging supplies used to manage lymphedema
- Accessories needed to apply or remove garments
Coverage includes both off-the-shelf (standard) and custom-made garments—when they are medically necessary. Important: Medicare requires documentation explaining why each item is needed and how often it must be replaced.
Understanding Lymphedema Stages
Your stage of lymphedema matters because it helps determine the type of compression you need. Your provider should clearly document your stage so coverage decisions are accurate.
ISL Lymphedema Classification System:
- Stage 0: At risk, but no visible swelling yet
- Stage 1: Swelling that comes and goes and improves with elevation
- Stage 2: Persistent swelling with skin thickening or firmness (fibrosis)
- Stage 3: Significant swelling with skin changes and altered limb shape
Why Documentation Matters So Much
Medicare looks for the answer to one key question, “Why does this patient need this specific item?” To receive coverage, your medical records must clearly explain:
- Where your lymphedema is located (arm, leg, breast, trunk, etc.)
- How severe it is
- How it affects your daily life
- What treatments you’ve tried
- Why specific compression items are needed
Why Some Patients Need Custom Compression Garments
Not everyone can use standard, ready-to-wear compression garments. You may need custom compression if you have:
- Significant size differences between parts of the limb
- Significant fibrosis (hard or thickened tissue)
- Skin folds or lobes
- High refill rate (the lymphedema comes back quickly)
Custom garments are designed specifically for your body to provide better containment, comfort and long-term protection.
What About Bandaging Supplies?
Some patients—especially those with moderate to severe lymphedema—require multi-layer compression bandaging. These supplies must be:
- Medically justified
- Prescribed by a physician
- Clearly listed by quantity and size
Important billing note: If your therapist bills Medicare for bandaging treatment codes 29581 or 29584, the therapist must provide the bandages themselves. The same supplies cannot be billed separately as durable medical equipment (DME) at the same time.
Daytime vs. Nighttime Compression
Many patients need different compression for day and night:
- Daytime garments help control swelling while you are upright and active.
- Nighttime garments address swelling that refills while you sleep as well as fibrotic changes.
Nighttime garments are often softer, bulkier, or padded and may be custom-made depending on your condition and needs.
Medicare vs. Medicare Advantage Plans
- Original Medicare follows the Lymphedema Treatment Act rules directly.
- Medicare Advantage Plans must also cover these items, but:
- They may require prior authorization.
- Quantities and timing may vary.
Always check with your DME supplier to confirm they are in network with your plan.
What About Medicaid or Private Insurance?
Coverage rules vary by state and insurance company. However, strong documentation still helps. At a minimum, records should include:
- Diagnosis
- Symptoms
- Duration of condition
- Impact on daily function
- Why standard garments are not sufficient (if applicable)
How You Can Advocate for Yourself
You deserve access to medically necessary care. The LTA has opened the door to better access—but documentation is the key that unlocks it. Understanding the process empowers you to ask the right questions and receive the care you need.
- Make sure your prescription is detailed with each compression item needed and is signed by your physician or authorized medical personnel.
- Keep copies of your records and orders.
- Work with a certified lymphedema therapist when possible.
- Ask to see your therapist's documentation concerning your compression garments and be sure that the referring physician is being sent this documentation.
If you feel overwhelmed, know that you are not alone. Advocacy groups, trained clinicians, and informed suppliers are here to help.
Disclaimer:?This information is solely for general education purposes—not as professional advice. Always seek advice of a qualified attorney or a healthcare professional if you need a medical diagnosis or treatment, as it relates to topics discussed. Do not disregard advice you have received, nor delay getting such advice, because of something you learn from this article.
Since the LTA passed, Juzo has taken an active role in both educating the lymphedema community about available benefits and advocating for fair coverage. Juzo also is a member of the U.S. Medical Compression Alliance (USMCA), a coalition of medical compression manufacturers that actively support implementation of the LTA. The USMCA advocates for ongoing patient access through coordination and execution of strategies for coding, coverage, and payment for medical gradient compression products.?