By Janet Wolfson, PT, CLWT, CWS, CLT-LANA I have blogged in the past about the Lymphedema Treatment Act (LTA), and I'm happy to report that the LTA is now a federal law, which was passed on December 23, 2022, by the 117th Congress.¹ It will amend Sec. 1861 [42 USC 1395x] of the Social Security Act to provide coverage for compression supplies that are “conservative, time-proven cornerstones of lymphedema treatment.”¹Lymphedema is a disease that “increase[s] [the] collection of lymphatic fluid in the body" and leads to swelling.² It is crucial to treat and manage lymphedema because, when it is not diagnosed, treated, and managed in its early stages, it can affect the patient's skin and tissue and may impact other health issues, too.³ Wound care professionals can use compression garments to treat lymphedema, and, in my experience, these garments decrease health care costs for patients and insurers by reducing hospitalization rates for infection and wound care. A patient’s quality of life can greatly increase, with a better ability for self-care, ability to work, and enhanced self-image.

A Historical Overview of its Significance

This act is necessary because compression garments were not covered under the Medicare definition of Durable Medical Equipment, defined as any equipment or supplies that a health care provider gives patients for daily use.⁴ Private insurance tends to follow similar guidelines. When Medicare was created in 1965 to establish a health insurance program for the elderly (along with Medicaid for those with limited income), it included specific definitions of covered diseases and treatments.⁵ However, lymphedema was not included during that time.

Where the Lymphedema Treatment Act Started

The first version of the LTA was introduced in 2010 in the 111th Congress by Heather Ferguson. ^1,6 Her son was born with lymphedema, and the lack of knowledge and coverage of care in the medical system spurred her to form the Lymphedema Advocacy Group (LAG). Instead of continually appealing for coverage of her son’s compression garments, she vowed to change it in the Medicare codes.⁷ While a companion senate bill was introduced in 2016, it has taken successive sessions of Congress to build support to pass the LTA eventually.

Where the Lymphedema Treatment Act Is at Today

Because Medicaid and private health insurance providers typically follow Medicare coding, the lymphedema community at large will likely benefit. Health care providers will now be better able to select the best compression garment for their patients, not just what they can afford. But still, the work continues. Throughout 2023, Medicare will work with LTA stakeholders and advocacy groups to define the products, services, and amount covered. Coverage for lymphedema treatments will begin in January 2024 for those with the diagnosis, regardless of cause. However, an official diagnosis must exist to make a claim. The law covers “standard and custom fitted gradient compression garments and other items determined by the Secretary,” allowing for flexibility in the choice of garment and future development of garments.⁸ Many questions remain about the reimbursement rate, including the following:

• What is the coverage time frame for replacement garments?
• How many replacement garments will be allotted at once?
• Who can bill for the garments and supplies?
• What are the new billing codes?

Staying Informed

Whenever there is new coverage or significant changes to existing coverage, the Centers for Medicare and Medicaid Services (CMS) is required to offer a public comment period. CMS will announce the public comment period 60 days before the preliminary rules are released, as required by law. There will be one for the LTA, likely mid-year during the summer months, and this will be an important opportunity for all stakeholders and advocates to act. The public may ask or petition an agency to issue, modify, or withdraw a rule. The CMS reviews these petitions to decide whether to take action. Your comments can be made online, by mail, or in person.

References

1. The Lymphedema Treatment Act Fact Sheet. LymphedemaTreatmentAct. 2022; https://lymphedematreatmentact.org/wp-content/uploads/2014/01/Lymphedem…
2. Sleigh BC, Manna B. Lymphedema. Updated September 18, 2022. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK537239/
3. Wolfson J. Compression Therapy and Lymphedema: Frequently Asked Questions. WoundSource. Published January 26, 2019. Accessed May 22, 2023. https://www.woundsource.com/blog/compression-therapy-and-lymphedema-fre…
4. Durable Medical Equipment (DME). HealthCare.gov. Accessed May 22, 2023. https://www.healthcare.gov/glossary/durable-medical-quipment-dme/
5. Medicare and Medicaid Act (1965). National Archives. Accessed May 22, 2023. https://www.archives.gov/milestone-documents/medicare-and-medicaid-act
6. Lymphedema Treatment Act. Medi USA. Accessed May 22, 2023. https://www.mediusa.com/medi-news/lymphedema-treatment-act-passed-by-co…
7. Background & History. LymphedemaTreatmentAct.org. Accessed May 22, 2023. https://lymphedematreatmentact.org/about-the-bill/background-informatio…
8. Frequently Asked Questions. LymphedemaTreatmentAct.org. Updated February 16, 2023. Accessed May 22, 2023. https://lymphedematreatmentact.org/wp-content/uploads/2023/02/FAQ-Docum…

About the Author

Janet Wolfson is a physical therapist and certified lymphedema therapist with over 30 years of field experience. She is certified in wound care and is currently an instructor in wound care and lymphedema treatment with ILWTI, and is Wound Care Coordinator at Encompass Health of Ocala. The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, HMP Global, its affiliates, or subsidiary companies. Information regarding coding, coverage, and payment is provided as a service to our readers. Every effort has been made to ensure accuracy. However, HMP and the author do not represent, guarantee, or warranty that coding, coverage, and payment information is error-free and/or that payment will be received.