The Lymphedema Treatment Act, passed in December 2022 and implemented on January 1, 2024, created a new Medicare benefit category for compression garments and supplies used in treating lymphedema. This guide outlines the steps patients need to follow when purchasing lymphedema garments online, along with eligibility requirements and coverage details.

Eligibility Requirements

Required Documentation

Before ordering lymphedema garments, you must have:

1. A formal diagnosis of lymphedema from a healthcare provider
2. A valid prescription (written order) from your physician, physician assistant, nurse practitioner, or clinical nurse specialist
3. A valid Medicare Insurance Coverage

Qualifying Diagnosis

To be eligible for coverage under the Lymphedema Treatment Act, you must have one of these four specific diagnosis codes:

• i89.0: Lymphedema, not elsewhere classified
• i97.2: Postmastectomy lymphedema syndrome
• i97.89: Other postprocedural complications and disorders of the circulatory system, not elsewhere classified
• Q82.0: Hereditary lymphedema

Steps for Purchasing Lymphedema Garments Online

1. Obtain a Prescription

• Schedule an appointment with your healthcare provider
• Ensure they document your lymphedema diagnosis with one of the qualifying diagnosis codes
• Get a written prescription for compression garments that specifies:
  • The type of garment(s) needed
  • The affected body part(s)
  • Compression level required (mmHg)
  • Whether standard or custom-fitted garments are needed
  • Whether daytime or nighttime garments are needed (or both)

2. Shop with Us - a Medicare-Enrolled Supplier

• Visit Lymphrx.com or call us at 877-713-6629
• We are an online supplier enrolled as a DMEPOS (Durable Medical Equipment, Prosthetics, Orthotics, and Supplies) supplier with Medicare

3. Provide Required Information

• Submit your prescription to us
• Provide your Medicare information
  • Full Name
  • Date of Birth
  • Phone Number
  • Address
  • Name of Insurance Company
  • Medicare Number
• Complete any supplier-specific forms for insurance verification
• Be prepared to provide measurements for the affected body part(s) - some suppliers may have specific measurement instructions or forms

4. Understand Payment Process

• We will file a Medicare claim on your behalf and we get reimbursed by Medicare.  We will take care of filing the claim.

5. Order Your Garments

• Select the specific garments prescribed by your healthcare provider. Our staff will be able to guide you.
• Provide accurate measurements as required by the supplier
  • standard garments and accessories can be ordered online and use standard size charts if applicable.
  • custom socks need to be measured by a certified fitter.
• Complete the ordering process on the supplier's website
• Keep copies of all receipts, prescriptions, and order confirmations

6. Wait for Delivery

• Once we have verified all the information and documents are, we then place your order and ship the garments to you.

Coverage Details

Covered Items

Medicare covers the following lymphedema compression treatment items:

• Standard and custom-fitted gradient compression garments
• Compression bandaging systems and supplies
• Gradient compression wraps with adjustable straps
• Accessories (donning/doffing aids, fillers, linings, padding, zippers)

Quantity Limitations

Medicare pays for compression garments as follows:

• Daytime garments: 3 garments per affected body part every 6 months
• Nighttime garments: 2 garments per affected body part every 2 years

Additional garments may be covered if:

• Items are lost, stolen, or irreparably damaged
• Your condition changes (e.g., change in limb size)

Pathway Steps

1. Schedule visit with clinician
2. Request documentation of the following:
   1. Clinical history and current symptoms
      1. ICD-10 diagnosis code: ICD-10 Code:
         1. I89.0: Lymphedema, not elsewhere classified
         2. Q82.0: Hereditary Lymphedema
         3. I97.2: Postmastectomy Lymphedema Syndrome
         4. I97.89: Other postprocedural complications and disorders of the circulatory system, not elsewhere classified
3. Treatment plan
   1. Is decongestive therapy appropriate and accessible?
   2. Is a garment currently needed to manage and/or maintain symptoms?
4. What type of products may be necessary
   1. Off the shelf or custom
   2. Daytime
   3. Nighttime
   4. Accessories
   5. Bandaging Supplies
5. Request a prescription
6. Identify a DME Supplier
   1. Determine if they are contracted with your health insurance provider
   2. Get measured and fitted for compression garments
   3. Make payment if needed (i.e., copay, coinsurance, deductible, cash pay)

Maintenance Patient Pathway

• 3 daytime compression garments every 6 months
• 2 nighttime compression garments every 2 years
• Accessories and bandaging supplies based on clinical need

• A garment is lost, stolen, or irreparably damaged
• They need a new garment or wrap due to a change in medical or physical condition

Pathway Steps