The Lymphedema Treatment Act - LTA
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.
Lymphedema Treatment Act Final Rule Coverage Summary
What will be covered:
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Custom and standard fit daytime and nighttime garments.
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Custom and standard fit gradient compression wraps with adjustable straps.
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Bandaging supplies for any phase of treatment.
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Accessories including but not limited to donning and doffing aids, padding, fillers, linings, and zippers.
Frequency allowances:
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Daytime garments - 3 sets (one garment for each affected body part) every six months, standard or custom fit, or a combination of both
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Nighttime garments - 2 sets (one garment for each affected body part) every two years, standard or custom fit, or a combination of both
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Bandaging supplies - no set limit in the rule.
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Accessories - no set limit, will be determined on a case-by-case basis depending on the needs of the patient.
Coverage requirements:
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To be eligible for the above coverage, a patient must have been diagnosed with lymphedema and have a prescription for the compression supplies.
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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.
Codes and reimbursement rates:
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57 codes specifically for lymphedema compression supplies will be created, and the rule also outlines the process for the creation of additional codes in the future if needed.
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This list of codes and their corresponding reimbursement rates will be released soon, and are not included in the final rule.
Deductibles and copay:
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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.
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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.
Pedors Shoes For Lymphedema
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.
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For swollen feet or relatively mild edema, we suggest the extra wide 2E width.
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For more severe edema or for venous insufficiency we recommend the extra, extra wide or 4E width.
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For individuals with lymphedema we recommend the extra, extra, extra wide or 6E width.
In Spring of 2024 the Classic Super MAX in a 10E width will be added to our core wholesale program, specifically designed for severe lymphedema and to accommodate compression wraps and bandages inside the shoe.
For wholesale customers interested in evaluating a pair of the Super MAX please visit our consumer website and at checkout use the code SneakPeek at check out to order a pair with wholesale pricing and free shipping. Limit 1 pair. Can be returned for a refund if necessary.
