Lymphedema Treatment Act: Eligibility, Coverage, and Costs

Medicare coverage for lymphedema compression garments took effect on January 1, 2024. Under Part B, if you have a documented lymphedema diagnosis and a prescription from your provider, Medicare pays for standard and custom compression garments, wraps, bandaging systems, and related accessories. You pay 20% of the Medicare-approved amount after meeting the annual Part B deductible, which is $283 in 2026.¹²

Who Qualifies

Coverage requires a documented diagnosis of lymphedema from your treating physician, physician assistant, or nurse practitioner. Both primary lymphedema (typically hereditary) and secondary lymphedema (developing after surgery, radiation, or injury) are covered. The prescriber must use one of four accepted ICD-10 codes when ordering:

I89.0 — Lymphedema, not elsewhere classified
Q82.0 — Hereditary lymphedema
I97.2 — Postmastectomy lymphedema syndrome
I97.89 — Other postprocedural complications of the circulatory system

Claims billed with any other diagnosis code are denied as noncovered, even if compression therapy is clinically appropriate.³ Compression stockings prescribed for chronic venous insufficiency alone, or elastic bandages for general swelling or sports injuries, fall outside this benefit.

What’s Covered

The benefit covers supplies used to manage swelling in any affected area, including upper and lower extremities:

Standard off-the-shelf daytime gradient compression garments sized to your measurements
Custom daytime garments when standard sizes don’t fit properly
Nighttime gradient compression garments designed for overnight use at lower pressure
Gradient compression wraps with adjustable straps
Multi-layer compression bandaging systems and components

Related accessories such as donning aids, padding, and liners are also covered when they support use of your primary garments.⁴ Your prescriber decides which combination is medically necessary based on the severity and location of your lymphedema. If a garment is prescribed as a surgical dressing rather than a lymphedema treatment item, it may be billed under a different Medicare category with different rules.⁵

How Often You Can Replace Garments

Medicare limits routine replacement to:

Three daytime garments or wraps per affected body part every six months
Two nighttime garments per affected body part every two years

You aren’t locked into those windows if your situation changes. Medicare will pay for a full new set outside the normal frequency in two circumstances: a change in your medical or physical condition (significant weight change, disease progression, surgery, or other change that makes current garments no longer fit or work), or loss, theft, or irreparable damage. When you replace early because of a medical change, the replacement clock restarts from the date you receive the new items.⁶ Your supplier must use the RA modifier when billing any replacement item.⁵

How to Get Your Supplies

Start with your prescriber. A physician, PA, or nurse practitioner writes a prescription that identifies the body area affected, the type and size of garment, and the clinical reason the items are medically necessary. If custom-fit garments are prescribed instead of standard sizes, the documentation should explain why standard options don’t work. Your medical record must also confirm that you’ve been instructed on how to use and care for the garments.⁵

Then bring the prescription to a Medicare-enrolled DMEPOS supplier (Durable Medical Equipment, Prosthetics, Orthotics, and Supplies). This is where claims most often fall apart: if the supplier isn’t enrolled in Medicare, the claim cannot be reimbursed at all.⁷ Verify enrollment first using Medicare’s supplier search at medicare.gov/medical-equipment-suppliers.⁸

The supplier bills Medicare directly. Standard sizes typically arrive within one to two weeks; custom garments can take three weeks or longer. Keep copies of the prescription and your records — you’ll need them when it’s time to reorder.

Your Out-of-Pocket Costs

Under Original Medicare Part B, you pay 20% of the Medicare-approved amount for each item after the annual deductible ($283 in 2026).¹² If you’ve already met the deductible through other Part B services this year, you owe only the 20% coinsurance.

A Medigap policy may cover some or all of that coinsurance depending on the plan. Medicare Advantage plans must cover everything Original Medicare covers, but cost-sharing and supplier networks vary by plan, and some plans require prior authorization. If you’re on Advantage, ask your plan about network suppliers and authorization before ordering.

If Medicare Denies Your Claim

Common denial reasons include missing documentation, an unsupported diagnosis code, or a supplier billing error. Read your Medicare Summary Notice carefully to see the specific reason. Often the fix is your prescriber or supplier resubmitting corrected paperwork rather than a formal appeal.

If the denial stands, file a Level 1 redetermination using CMS Form 20027.⁹ You have 120 days from the date on your Medicare Summary Notice or Remittance Advice. Medicare adds five days for mailing, and a deadline that lands on a weekend or holiday rolls to the next business day.¹⁰ Include:

A copy of the denial notice
Your Medicare number and the date you received the item
A written explanation of why you disagree
Supporting evidence — updated medical records or a letter of medical necessity from your prescriber

Send all supporting evidence with the initial request; the reviewer decides on the record in front of them. If redetermination goes against you, four more appeal levels are available, each handled by a different entity. Your State Health Insurance Assistance Program (SHIP) offers free help at any stage.¹¹

1
Medicare.gov. Lymphedema Compression Treatment Items
2
Centers for Medicare & Medicaid Services. 2026 Medicare Parts A and B Premiums and Deductibles
3
Noridian Medicare. Lymphedema Compression Treatment
4
Social Security Administration. Social Security Act Title XVIII – 1861
5
Centers for Medicare & Medicaid Services. Lymphedema Compression Treatment Items – Implementation
6
Noridian Medicare. Lymphedema Compression Treatment Items – Correct Coding and Billing
7
Centers for Medicare & Medicaid Services. Enroll as a DMEPOS Supplier
8
Medicare.gov. Durable Medical Equipment Cost Compare
9
Centers for Medicare & Medicaid Services. Medicare Redetermination Request Form CMS-20027
10
Noridian Medicare. Appeals Timeliness Calculators
11
Medicare.gov. Filing an Appeal