Living with lymphedema is expensive—compression garments, wraps, nighttime products, and bandaging supplies aren’t “nice to have.” They’re part of day-to-day medical management. The good news: Medicare now covers lymphedema compression treatment items when they’re prescribed and medically necessary.
This guide is designed as a knowledge base for people with lymphedema (and caregivers) who want to use Medicare to help cover costs. It includes:
- What Medicare Covers (and What It Doesn’t)
- Who’s Eligible
- Step-by-Step on How to Order Correctly
- Reordering Rules (The Biggest Source of Confusion)
- Replacement Rules (Lost/Damaged/Size Changes)
- Tips to Avoid Denials
- A Robust FAQ at the end
Quick note: Coverage details can vary by plan type (Original Medicare vs Medicare Advantage) and by documentation. The info below is based on Medicare/CMS guidance and DME MAC publications.
1) The Medicare Lymphedema Benefit in Plain English
Medicare covers certain “lymphedema compression treatment items” to help control swelling and support long-term management.
Medicare may cover these items when:
- You have a lymphedema diagnosis, and
- A doctor or other qualified health care provider prescribes the items as part of treatment.
Medicare’s coverage is for lymphedema regardless of cause (for example, cancer-related or non-cancer-related), but claims must be billed with a lymphedema diagnosis—non-lymphedema diagnoses aren’t covered under this benefit.
2) What Medicare Covers for Lymphedema
Medicare’s covered categories include:
A) Daytime Gradient Compression Garments
- Standard (Off-the-Shelf) daytime compression garments
- Custom-Fitted daytime garments (uniquely sized/shaped to your measurements)
B) Nighttime Gradient Compression Garments
These are designed for use when resting/sleeping (often foam/quilting or other nighttime-specific construction).
C) Gradient Compression Wraps with Adjustable Straps (often called “Velcro Wraps”)
These are adjustable compression wraps used commonly for fluctuating swelling, shape changes, or when a person needs easier donning/doffing.
Example HCPCS code shown in CMS guidance: A6583 (below-knee adjustable wrap, 30–50 mmHg).
D) Compression Bandaging Supplies (for Acute/Decongestive Therapy and Maintenance)
Medicare covers compression bandaging supplies when medically necessary for lymphedema treatment.
E) Accessories Needed for Effective Use
Examples include things like zippers, padding/fillers, linings—items that are necessary to use the garment or wrap effectively.
3) What Medicare Doesn’t Cover (Common Misconceptions)
A few frequent pain points:
- Compression for non-lymphedema diagnoses (e.g., venous issues without lymphedema) is not covered under this specific lymphedema benefit.
- If documentation doesn’t support medical necessity (or the wrong diagnosis code is used), claims can deny.
- Medicare has quantity/frequency limits for garments and wraps (more on this below).
4) Eligibility: Who Qualifies?
According to Medicare, you may be covered if:
- You’ve been diagnosed with lymphedema, and
- Your provider prescribes covered compression items.
Important operational rule: Items must be provided by an enrolled DMEPOS supplier for Medicare Part B payment.
That means: even if a clinician measures you, supplies must generally be billed through a Medicare-enrolled DMEPOS supplier to be paid under Part B.
5) Original Medicare vs Medicare Advantage: What Changes?
Original Medicare (Part B)
- These items are paid under Medicare Part B rules. CMS guidance explains that Part B deductible and coinsurance apply, and Medicare typically pays 80% of the allowed amount after the deductible (you pay the remainder unless you have secondary coverage).
Medicare Advantage (Part C)
Medicare Advantage plans must cover what Original Medicare covers, but plan rules can differ—for example:
- Prior authorization
- Network restrictions (must use in-network supplier)
- Different documentation workflows Advocacy guidance specifically notes MA plans must cover the same categories, but “terms of coverage can differ.”
Practical tip: If you have Medicare Advantage, call your plan and ask:
- Are there special ordering steps or preferred brands?
- Do I need prior authorization for lymphedema compression treatment items?
- Which DME suppliers are in-network?
6) Reordering Rules: How Often Can You Get New Items?
This is the #1 question we hear. Medicare’s national frequency limits are clear:
Daytime Garments / Adjustable Wraps
- 3 items per affected body part every 6 months
Nighttime Garments
- 2 items per affected body part every 2 years
Bandaging Supplies & Accessories
- Covered when medically necessary for lymphedema treatment (these don’t follow the same fixed garment frequency language).
What Counts as a “Body Part”?
CMS uses the language “affected extremity or part of the body.”
So, if you have lymphedema in more than one area (for example, both legs), coverage can apply to each affected area—documentation and correct billing matter.
7) Replacement Rules: Lost, Damaged, or Your Body Changes
Outside routine reorders, Medicare can pay for replacements when:
- The garment/wrap is lost, stolen, or irreparably damaged, or
- Your medical condition changes enough that you need a new size or type.
Key detail: Replacement billing uses the RA modifier, and replacement still interacts with frequency “clocks.” CMS instructions describe that replacement can restart the frequency timing based on the date of service for the replacement.
Real-world example: If you replace one daytime garment early due to damage, Medicare may allow replacement—but the 6-month timing can reset from that replacement date.
8) What You Need to Get Medicare to Pay (Documentation Checklist)
Medicare coverage is much smoother when the basics are done right. Here’s a practical checklist:
Provider’s Side (Usually Your Doctor/NP/PA)
- A documented lymphedema diagnosis (correct diagnosis code on the claim)
- A prescription/order for the specific item category (daytime garment, nighttime garment, adjustable wrap, bandaging supplies)
- Clinical notes that support why compression is medically necessary (severity, swelling, fibrosis, skin changes, history of cellulitis risk, functional limits—whatever applies)
Measurement & Product Selection (Often Your Therapist + Supplier)
- Accurate measurements (and re-measurements if swelling fluctuates)
- Match the item type to the treatment need (standard vs custom, garment vs wrap, daytime vs nighttime)
Supplier Side (DMEPOS Supplier)
- Must be enrolled as a DMEPOS supplier to bill Medicare for these items
- Correct coding and claim submission (including correct HCPCS, modifiers, and diagnosis)
9) Understanding Codes (Without Getting Overwhelmed)
You do not need to be a coding expert to use Medicare successfully—but it helps to recognize common terms:
- Medicare uses HCPCS codes to describe what’s being billed.
- For adjustable wraps, CMS implementation guidance includes codes such as A6583 (example listed in CMS publications).
- DME MAC publications provide correct coding/billing rules and emphasize that claims for non-lymphedema diagnoses are noncovered.
Practical takeaway: A knowledgeable supplier will map your prescribed item to the correct code and ensure your claim aligns with Medicare rules.
10) Step-by-Step: How to Get Medicare-Covered Compression Items
Step 1: Confirm Your Medicare Type
- Original Medicare (Part B)
- Medicare Advantage (Part C). If you’re on Advantage, also confirm network and authorization requirements.
Step 2: Get a Lymphedema-Focused Prescription
Ask your provider to prescribe the appropriate category:
- Daytime garment(s) and/or adjustable wrap(s)
- Nighttime garment(s)
- Bandaging supplies/accessories (if clinically appropriate)
Step 3: Get Measured (and Choose the Right Item Type)
A lymphedema therapist or trained fitter can help determine whether you need:
- Standard vs Custom Fit
- Garment vs Adjustable Wrap
- Daytime vs Nighttime Garments
Need a Therapist: Find one near you by using the Therapist Referral Form by the Norton School of Lymphatic Therapy.
Step 4: Work with a Medicare Enrolled DMEPOS Supplier
This step is essential for coverage under Part B payment rules.
Step 5: Track Your Reorder Dates
Because limits are time-based (6 months / 2 years), it helps to keep a simple log:
- Date of Service
- Item Type (Daytime vs Nighttime)
- Body Part
- Quantity Received
11) How to Avoid Denials (and What to Do if You Get Denied)
Common Reasons Claims Deny
- Diagnosis mismatch (not coded as lymphedema)
- Exceeded frequency limits (too many items too soon)
- Supplier not properly enrolled as DMEPOS for billing these items
- Documentation doesn’t support medical necessity (especially for custom items)
If You Get Denied
- Ask your supplier for the denial reason code/explanation
- Confirm the diagnosis code on the claim is a lymphedema ICD-10 (your clinician can help)
- If it’s a timing issue, check whether you’re inside the 6-month or 2-year window
- If it’s a medical-change replacement (new size/type), ensure the clinician notes clearly describe the change
Frequently Asked Questions (FAQs)
Does Medicare cover compression garments for lymphedema?
Yes. Medicare may cover daytime gradient compression garments, custom garments, nighttime garments, adjustable wraps, bandaging supplies, and certain accessories when you have lymphedema and your provider prescribes them.
How many compression garments does Medicare cover?
Medicare pays for:
- 2 nighttime garments per affected body part every 2 years
- 3 daytime garments or wraps per affected body part every 6 months
Can I reorder early if my garment is worn out?
Medicare has frequency limits, but replacements can be covered if items are lost, stolen, irreparably damaged, or if your condition changes enough to require a new size/type—documentation matters.
What if my swelling changes and I need a different size?
Medicare can pay for a new size/type when your condition changes enough to warrant it. Make sure your clinician documents the change.
Are Velcro compression wraps covered by Medicare?
Yes—Medicare may cover gradient compression wraps with adjustable straps when prescribed for lymphedema. CMS guidance includes wrap codes such as A6583 as an example.
Do I need to buy from a specific kind of supplier?
For Medicare Part B payment, items must be furnished and billed by an enrolled DMEPOS supplier.
Does Medicare Advantage cover the same lymphedema items?
Medicare Advantage plans must cover what Original Medicare covers, but the process may differ (network suppliers, prior authorization, plan rules).
Do Part B deductible and co-insurance apply?
Yes. CMS instructions indicate Part B deductible and coinsurance apply, and Medicare payment is typically 80% of the allowed amount after the deductible (with the remaining amount covered by you or secondary insurance).
Can Medicare cover bandaging supplies too?
Yes—compression bandaging supplies are included as a covered category when medically necessary for lymphedema treatment, but not all supplies offers compression bandages as part of their options when using insurance.
What diagnosis do I need for Medicare to pay?
Claims must be billed with a lymphedema diagnosis; coverage under this benefit is prohibited for non-lymphedema diagnoses. Your clinician and supplier should coordinate so the claim includes a lymphedema ICD-10.
