CMS Lymphedema Compression Coverage Resource Guide

Everything you need to know about the Lymphedema Treatment Act, all in one place.

Updates You May Have Missed on the CMS Compression Guidelines

CMS has released their final rule regarding the implementation of the Compression Guidelines which outlines how they intend to begin covering compression garments and related accessories for patients diagnosed with lymphedema. The full 65-page document can be viewed here (beginning on page 350). Below is a summary of some of the key provisions of the final rule:

Covered items: The following items will be covered by Medicare beginning Jan. 1, 2024, for patients diagnosed with lymphedema:

  • both standard and custom-fitted gradient compression garments
  • gradient compression wraps with adjustable straps
  • compression bandaging systems
  • other items determined to be lymphedema compression treatment items

Frequency limitations: Medicare will cover:

  • Three daytime garments or wraps with adjustable straps for each affected limb or area of the body, replaced every six months.
  • Two nighttime garments for each affected limb or area of the body, replaced once every two years.
    • *These limitations are higher than what was originally suggested in the proposed rule, and industry stakeholder comments played a key role in raising the frequency limitations that were finalized.

HCPCS Codes: There are a couple tables contained within the final rule, namely tables FF-A 1 and FF-A 2, which outline the codes that will be used to represent many of the compression-related products used to treat patients with lymphedema.

  • CMS is keeping several of the existing compression codes that several of you may already be familiar with (A6530-A6549 range). These are outlined in Table FF-A 1 on page 372.
  • CMS is creating 57 new HCPCS codes to better represent additional lymphedema-related compression products. These new HCPCS codes have yet to be determined, but the descriptions of each new code can be found in Table FF-A 2 on page 389.
  • CMS is creating nine additional new A-codes to replace nine existing S-codes (S8420-S8428) that currently represent compression sleeves, gloves, gauntlets, wraps, and bandages.

Pricing/Reimbursement: CMS has finalized the full fee schedule for 2024 and has included in that fee schedule several new HCPCS codes and corresponding reimbursement rates for compression garments and related accessories. The full 2024 DMEPOS fee schedule can be found here. We have also included a separate resource that only highlights the compression garment and related accessory codes for this new product category.

New Product Category – Accreditation and Updating Your 855S Form: CMS is treating this as a new benefit category, and with that comes a requirement for separate accreditation. We encourage suppliers to reach out to their respective accreditation organizations to find out what they need to do to be able to provide and bill for these compression products moving forward. CMS is still in the process of updating the 855-S, which will likely not be completed until Feb. 2024 or later.VGM and EW will continue to monitor the information that is released regarding this topic, and will provide you with additional updates as appropriate. Please don’t hesitate to reach out to our VGM Government and Regulatory team at 800-642-6065 if you have additional questions.

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