Compression garments for Lymphedema - Medicare Advantage

Policy No: 150
Date of Origin: 04/01/2024
Section: Administrative
Last Reviewed:
Last Revised:
Approved: 06/13/2024
Effective: 07/01/2024
Policy Applies To: Medicare Advantage

This policy applies to physicians and suppliers and other qualified health care professionals, including DMEPOS suppliers.

Compression Garments: Special clothing containing elastomeric fibers and yarns used to apply substantial mechanical pressure on the surface of needed body zones for stabilizing, compressing, and supporting underlying tissues. Examples include:

• Standard daytime gradient compression garments;
• Custom daytime gradient compression garments;
• Nighttime gradient compression garments;
• Gradient compression wraps;
• Accessories (e.g., zippers, linings, padding or fillers, etc.) necessary for the effective use of a gradient compression garment or wrap; and

• Compression bandaging systems/supplies

Custom Durable Medical Equipment (DME): Custom Items are rarely necessary and are rarely furnished. Must be uniquely constructed or substantially modified for a specific beneficiary according to the description and orders of a physician and be so different from another item used for the same purpose that the two items cannot be grouped together for pricing purposes. Items that are measured, assembled, fitted, or adapted in consideration of a patient’s body size, weight, disability, period of need, or intended use (i.e., custom fitted items) do not meet the definition of customized items. An example of a genuine custom item would be a wheelchair that is modified to allow conjoined twins to use it in such a way that no other beneficiary could ever use it. An example of an item that is not a custom item would be a compression garment that comes in a variety of sizes, even if the beneficiary’s leg were measured for the item to determine which preset size they would be getting. This compression garment example would be a custom fitted item, not a Custom DME item.

Lymphedema: A chronic disease marked by the increased collection of lymphatic fluid in the body, causing swelling, which can lead to skin and tissue changes.

Our health plan provides coverage for standard, and custom fitted gradient compression garments and other approved items that are prescribed by a physician or other specified health care professional for treatment of lymphedema following Centers of Medicare and Medicaid (CMS) guidelines.

The right (RT) and left (LT) modifiers must be used with gradient compression garments, related supplies, and accessories when laterality is indicated.

Lymphedema compression garments may be billed for more than one body part or area per patient. Daytime and nighttime garments can be billed for the same body part or area for the following frequency:

• Once every 6 months for 3 daytime gradient compression garments or wraps with adjustable straps per each affected extremity or part of the body
• Once every 2 years for 2 nighttime garments per each affected extremity or part of the body

Centers for Medicare & Medicaid Services (CMS), HCPCS Level II codes

Centers for Medicare and Medicaid (CMS), Lymphedema Compression Treatment Items Implementation

Noridian Healthcare Solutions – DME Jurisdiction D

Medical Policy M-DME92 – Medicare – Gradient Compression Garments (Excluding Burn Garments)

Medical Policy M-DME75 – Medicare – Durable Medical Equipment, Prosthetic and Orthotic Upgrades, Replacements, Duplicates, and Repairs

DME Purchase and Rental Limitations and Reimbursement

Medicare-Based Fee Effective Dates

Bundling Edits

Non-Reimbursable Services