Lymphedema Insurance Coverage Q&A | Juzo USA
January 2024

Lymphedema Insurance Coverage Q&A

Carmen Anderson, MS, CCC, SLP Reimbursement & Market Access Consultant

Insurance coverage for patients in need of medical compression to help manage lymphedema outlined in the Lymphedema Treatment Act (LTA) went into effect Jan. 1, 2024. Juzo has been working with Reimbursement Consultant Carmen Anderson to help patients, medical professionals and authorized Juzo dealers better understand the legislation. She answers some commonly asked questions below.

What is the Lymphedema Treatment Act?
The LTA is a pivotal piece of legislation to help patients impacted by lymphedema. Congress passed it in December 2022. The goal of the legislation was to create a new Medicare benefit category to provide insurance coverage for medical compression treatment garments and accessories to help manage lymphedema. Coverage went into effect Jan. 1, 2024.

What types of lymphedema compression items are covered?
Per Medicare, insurance coverage for the following items will be available for patients diagnosed with lymphedema—on an individual, claim-by-claim basis:

  • Custom and standard compression garments, including daytime, wraps and nighttime products
  • Bandages used during treatment phases (decongestive and/or maintenance)
  • Accessories, including, but not limited to, donning and doffing aids, padding, fillers, linings, and zippers

Find out more from Medicare

How many garments are covered by CMS?
The Centers for Medicare and Medicaid Services (CMS) have determined the following frequency allowance for patients:

  • Daytime: three products (for each affected body part) every six months
  • Nighttime: two products (for each affected body part) every two years
  • Bandages: based on need
  • Accessories: based on need

What happens if I damage or lose my garment, or if it no longer fits?
CMS will replace your garment if it is lost, stolen or irreparably damaged. If your condition (limb size) changes, CMS will also replace your garment with proper documentation from a medical professional.

What type of insurance coverage is available for lymphedema garments?
To be eligible for coverage, you must have a lymphedema diagnosis, prescription, and additional documentation for compression products. There is no retroactive coverage for products purchased prior to Jan. 1, 2024. For traditional Medicare, compression garments and 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.

Was Juzo involved in shaping lymphedema coverage?
While Juzo was not involved in drafting the legislation, key representatives from Juzo have helped inform CMS on lymphedema and the benefits of medical compression to advocate for adequate coverage. Also, Juzo is part of the United States Medical Compression Alliance (USMCA), composed of prominent compression garment manufacturers, that has worked with industry leaders, advocacy groups and clinical organizations over the last year to help ensure patients have optimal access to medically necessary compression products. Juzo will continue to those who prescribe and provide medical compression garments to patients navigate the new insurance coverage and reimbursement process through advocacy, education and other efforts.


Talk with your authorized Juzo dealer and care team to get properly fitted for medical compression garments and find out what may work best for you. They also can help you understand the new insurance coverage available.

Follow us on Instagram, @JuzoCompression, and Facebook to learn more about Juzo products, programs and ways we support the lymphedema community.

Kristy Newman commented on Jun 30, 2024
Reply

I have been trying to get the right ones and I'm told that I had to pay out of pocket

Cyndy commented on May 15, 2024
Reply

So, will Medicare cover the cost of compression stockings now?

Juzo replied to Cyndy on Jun 10, 2024

Hi Cyndy, If you have lymphedema or an open wound, Medicare will pay for compression stockings. If you have private insurance, we suggest that you contact your insurance provider to ask if they cover compression stockings in your plan.

Elly commented on Apr 18, 2024
Reply

Is there a possibility prescribed stockings may be covered for poor circulation now or later?

Angela Corwin commented on Apr 05, 2024
Reply

Does this law also apply to company supported plans such as Anthem Blue Cross Blue Shield?

Juzo replied to Angela Corwin on Apr 15, 2024

Hi Angela The Lymphedema Treatment Act mandated the addition of a new benefit category for Medicare members. We suggest that you contact your insurance provider to ask if they will add coverage to your private insurance plan.

Donna Thomas commented on Mar 20, 2024
Reply

I have Medicare and my Dr gave me a prescription for compressionstockimgs

Juzo replied to Donna Thomas on Mar 22, 2024

Hi Donna Visit our Juzo Dealer locator to find a certified compression specialist near you and call to confirm that they can bill medicare.

BC commented on Mar 10, 2024
Reply

Can I order My Juzo compression garments on line and will they be covered by Medicare?

Juzo replied to BC on Mar 22, 2024

Hi BC Some online compression retailers can bill Medicare; we recommend contacting their customer service to confirm that they can bill Medicare.

Judy Thomas commented on Feb 29, 2024
Reply

I have been wearing Juzo products for over 30 years. I was informed today that the dynamic 30-40mmHG open crotch pantyhose are now going to be a custom product. To wear the compression garments and try to get them down and back up to go to the bathroom without gloves is impossible. The open crotch makes going to the bathroom one thing that doesn't increase the reminder of having health issues. The cost of the off the shelf 3512AT is $149, the cost of a custom one will be over $500. How is someone with a disability to afford this. Yes, I know that Medicare will now pay for 3 pair every 6 months. That is not enough pair of hose to keep up with for everyday life. Especially if you are not in your home environment. Those of us with severe health issues do not need one more thing in our lives that are difficult. Our lives are difficult enough. Please make the dynamic 30-40mmHG open crotch pantyhose off the shelf as before. I do not have the option to wear thigh high hose, or I would get those. I have to wear the pantyhose. Please don't make these a custom product. PLEASE!!!

Lena / Warren's Apothecary commented on Feb 28, 2024
Reply

The HCPCS code for compression sleeves with Juzo as the manufacturer is not pulling anything up in the PDAC's DMEPOS Product Classification List. Do you know when those classifications will be approved for the Juzo product line?

Juzo replied to Lena / Warren's Apothecary on Mar 05, 2024

Hi Lena ? To best of our knowledge, PDAC is working on the coding review process. Medicare suggests using the correct HCPCS codes defined in coverage for products serviced. For additional questions and direction, we recommend calling the Pricing, Data Analysis and Coding Helpline: (877) 735-1326

J LO commented on Feb 07, 2024
Reply

Does Medicare allow you to pick pretty designs, which would be awesome, or do they just allow the basic colors, which sometimes include pink?

Juzo replied to J LO on Feb 13, 2024

Hi J. We suggest discussing your garment options with your certified Juzo dealer to ensure you get what you need and want.

Juzo commented on Feb 05, 2024
Reply

Hi Pamela You must purchase your compression supplies from a Medicare-approved supplier, such as a Home Medical Equipment provider, Pharmacy, or Women's boutique, who can bill Medicare. For more information, visit the Medicare URL below. https://www.medicare.gov/coverage/lymphedema-compression-treatment-items

Robert Koffel commented on Feb 04, 2024
Reply

Great news. I will need two sleeves shortly. I am going to call the doctor'f office tomorrow. Should I have him email the prescription to you or what should I do with it?

Juzo replied to Robert Koffel on Feb 07, 2024

Hi Robert, we don't sell directly to customers. Please visit the Juzo Dealer locator page to find a certified compression specialist who can assist you. Here's the URL: https://www.juzousa.com/Find-Juzo-Dealers

Pamela McKay commented on Jan 31, 2024
Reply

Sounds great. I just ordered a sleeve 2 days ago from Amazon. How can I get it covered with my insurance.

 
 

Popular Blog Articles:

From October 2018
From April 2019
From January 2023
From April 2022
From May 2024
Julius Zorn, Inc. • 3690 Zorn Drive • Cuyahoga Falls, OH 44223 • Call: 1-888-255-1300
Juzo Canada, Ltd. • 1100 Burloak Drive, Ste. 300 • Burlington, ON L7L 6B2 • Call: 1-888-255-1300

Copyright 2024 Julius Zorn, Inc.
Privacy Policies & Disclaimers
Login