As of January 1, 2024, Medicare has expanded its coverage to include lymphedema compression treatment items, significantly impacting Durable Medical Equipment (DME) and Home Medical Equipment (HME) providers. Understanding these updates is crucial for ensuring compliance and optimizing patient care.
Covered Items:
Medicare now covers both standard and custom-fitted lymphedema compression treatment items for each affected body part. This includes:
- Gradient compression garments for daytime and nighttime use
- Compression bandaging systems and supplies
- Gradient compression wraps with adjustable straps
- Necessary accessories such as aids for donning and doffing, fillers, linings, padding, and zippers
Frequency of Coverage:
- Daytime Garments: Up to 3 garments per affected body part every 6 months.
- Nighttime Garments: Up to 2 garments per affected body part every 2 years.
Replacements are also covered in cases of loss, theft, irreparable damage, or significant changes in the patient’s condition.
Eligibility and Prescribing:
Patients must have Medicare Part B coverage and a prescription from an authorized practitioner to be eligible. The prescribed items must be primarily and customarily used to treat lymphedema.
Supplier Enrollment:
Providers must be enrolled as Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) suppliers to receive Medicare payments for these items. New applicants should include a letter specifying their intent to supply lymphedema compression treatment items with their application.
Provider Responsibilities:
Enrolled suppliers are responsible for all aspects of providing these items, including:
- Taking measurements
- Fitting services
- Patient training on usage and maintenance
- Item adjustments as necessary
While external fitters can be employed, the enrolled DMEPOS supplier holds ultimate responsibility.
Billing Information:
Effective January 1, 2024, providers should utilize the new and existing codes as outlined in the January 2024 Alpha-Numeric HCPCS File.
These updates represent a significant advancement in supporting patients with lymphedema. DME and HME provider should familiarize themselves with these changes to ensure seamless integration into their services
