For more detailed information on the Lymphedema Treatment Act please visit the Lymphedema Advocacy Group at https://lymphedematreatmentact.org/
The Lymphedema Treatment Act created a Medicare benefit category for lymphedema compression supplies that goes into effect January 1st 2024.
In order to qualify for coverage of compression supplies a Medicare beneficiary will have to have a diagnosis of lymphedema. In order to bill for lymphedema compression items under the new benefit category a Medicare Provider will need to be a Medicare Supplier.
• Custom and standard fit daytime and nighttime garments.
• Custom and standard fit gradient compression wraps with adjustable straps.
• Bandaging supplies for any phase of treatment.
• Accessories including but not limited to donning and doffing aids, padding, fillers, linings, and zippers.
• Daytime garments - 3 sets (one garment for each affected body part) every six months, standard or custom fit, or a combination of both.
• Nighttime garments - 2 sets (one garment for each affected body part) every two years, standard or custom fit, or a combination of both.
• Bandaging supplies - no set limit in the rule.
• Accessories - no set limit, will be determined on a case-by-case basis depending on the needs of the patient.
• To be eligible for the above coverage, a patient must have been diagnosed with lymphedema and have a prescription for the compression supplies.
• The coverage will begin January 1, 2024. There will be no retroactive coverage, meaning, you cannot submit claims for any garments or supplies purchased or ordered before 1/1/2024.
• For traditional Medicare -- these supplies will be covered under Part B, so the annual Part B deductible and 20% coinsurance apply to all compression supplies.
• For Medicare Advantage and all other types of insurance -- out-of-pocket costs will vary depending on the specific terms of your plan. It is likely that your compression supplies will be subject to the same copay and deductibles as supplies covered under the DMEPOS (Durable Medical Equipment, Prosthetic and Orthotic Supplies) section of your policy.
The Pedors Classic MAX are available in 2E, 4E and 6E widths and have been designed to accommodate feet at various degrees of swelling with our proprietary Pedoprene upper providing both accommodation and therapeutic compression.
• For swollen feet or relatively mild edema, we suggest the extra wide 2E width.
• For more severe edema or for venous insufficiency we recommend the extra, extra wide or 4E width.
• For individuals with lymphedema we recommend the extra, extra, extra wide or 6E width.
The Classic Super MAX in a 10E width are specifically designed for severe lymphedema and to accommodate compression wraps and bandages inside the shoe.