If your doctor has prescribed compression garments for lymphedema or swelling, your first question is likely: "Will my insurance pay for this?" As a seasoned medical biller, I’ve seen how confusing—and frustrating—this process can be.
The good news? As of January 1, 2024, Medicare now covers compression garments for lymphedema under the Lymphedema Treatment Act (LTA). Commercial insurance coverage varies, but many private payers do offer partial or full reimbursement.
Here’s what you need to know to get approved.
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🧾 Medicare Now Covers Compression Garments (2024 Update)
Historically, Medicare did not pay for compression garments, considering them non-durable supplies. That changed when Congress passed the Lymphedema Treatment Act, which went into effect on January 1, 2024.
✅ What’s Covered:
Under Medicare Part B, patients with a diagnosis of lymphedema are now eligible for:
- Compression stockings
- Arm sleeves
- Gauntlets and gloves
- Compression wraps and bandages
- Donning/doffing aids (e.g., gloves or applicators)
✅ What You Need:
- A prescription from a licensed provider
- A qualifying ICD-10 diagnosis code (see below)
- A Medicare-enrolled supplier to dispense the garments
- Accurate HCPCS billing codes
📋 Medicare-Approved Diagnosis Codes for Lymphedema
These are the only ICD-10 codes accepted by Medicare for compression garment coverage as of 2024:
| ICD-10 Code | Description |
|---|---|
| I89.0 | Lymphedema, not elsewhere classified |
| Q82.0 | Hereditary lymphedema |
| I97.2 | Postmastectomy lymphedema syndrome |
| I97.89 | Other postprocedural circulatory complications |
🔒 If the patient has any other diagnosis—like chronic venous insufficiency or varicose veins—Medicare will likely deny the claim.
🏥 Commercial Insurance: Broader, but Inconsistent
Commercial plans (Aetna, Cigna, BCBS, UHC, etc.) often cover compression garments for conditions beyond lymphedema, including:
- Chronic Venous Insufficiency (I87.2)
- Varicose Veins with Ulcer (I83.10)
- Deep Vein Thrombosis (I82.40)
- Post-operative swelling
But coverage depends on the policy. Some require prior authorization, others have yearly limits, and a few exclude custom garments.
🧠 Pro tip: Call the insurance company and ask:
"Does my plan cover compression garments for [diagnosis] with a prescription?"
🧾 Billing 101: How to Get Compression Garments Covered
Step 1: Get a Prescription
Your provider must include:
- Diagnosis (ICD-10)
- Garment type and compression strength (e.g., 20–30 mmHg thigh-high stocking)
- Duration and frequency of use
Step 2: Use a Participating DME Supplier
The supplier must be:
- Medicare-enrolled (for Medicare claims)
- In-network (for commercial insurance)
- Able to bill with HCPCS codes (e.g., A6531)
Step 3: Submit a Clean Claim
Use:
- Correct HCPCS and ICD-10 codes
- Side modifiers if applicable (e.g., RT, LT)
- Documentation (e.g., physician notes, plan of care)
Step 4: Follow Up or Appeal if Denied
Many claims are denied due to:
- Wrong codes
- Missing records
- Non-covered diagnosis
You can appeal with a Letter of Medical Necessity and clinical notes.
💸 What If It’s Not Covered?
If your garments aren’t covered, try:
- FSA/HSA: Most compression garments are eligible
- Manufacturer programs: Some offer patient discounts
- Out-of-network reimbursement: Buy the item, then submit the receipt for possible reimbursement.
📌 Summary Checklist
| Requirement | Medicare | Commercial Insurance |
|---|---|---|
| Lymphedema Diagnosis | ✅ Required | ✅ Often Covered |
| Other Diagnoses (e.g., CVI, DVT) | ❌ Not Covered | ✅ Sometimes |
| Custom Garments | ✅ Covered | ✅ Often Covered |
| Prior Authorization | ❌ Usually Not | ✅ Often Required |
| HCPCS Billing | ✅ Required | ✅ Required |
🧾 Need Help?
If you're overwhelmed with codes, coverage policies, or where to buy, we’ve got you.
Pro Therapy Supplies helps patients get compression garments that are insurance-eligible, Medicare-approved, and professionally fitted when needed.
→ Visit our website or call our support team today.
🛒 Shop Compression Garments with Insurance Assistance
At Pro Therapy Supplies, we make it easy to:
- Get Medicare-covered compression sleeves and wraps
- Submit claims to commercial insurance
- Find the right garment, size, and compression strength
- Get help from real billing experts
👉 Browse Our Compression Garments
📚 Sources
- CMS – Lymphedema Treatment Act Overview (2024)
- Lymphedema Treatment Act Website
- Medicare.gov – DME Suppliers Directory
- Noridian DME MAC – Billing Guidelines
- Aetna Compression Therapy Policy
and then Add to Home Screen.
