Georgia Medicare Lymphedema Treatment Act Compression Items 2026

Since January 1, 2024, Medicare Part B has covered the lymphedema compression garments and bandaging supplies that Georgia beneficiaries wear every day to manage the disease. The Lymphedema Treatment Act created that Georgia Medicare benefit after a two-decade coverage gap, and you pay only the standard 20% Part B coinsurance after your deductible.1

If you live in Georgia, are on Medicare, and developed lymphedema after cancer treatment or have lived with primary lymphedema for years, this is the coverage change to know. It applies whether your lymphedema followed breast cancer treatment, gynecologic cancer surgery, prostate cancer treatment, melanoma surgery, or head and neck cancer therapy, or whether you have primary lymphedema you have lived with since birth or childhood.

For more than two decades, Medicare paid for outpatient therapy to treat lymphedema (complete decongestive therapy by certified lymphedema therapists at Emory, Wellstar, Piedmont, Augusta University, Memorial Health Savannah, Phoebe Putney, Northeast Georgia, Atrium Health Navicent, and elsewhere). But Medicare did not pay for the compression garments and bandaging systems beneficiaries had to wear every day, for the rest of their lives, to keep the disease from progressing. Compression garments are expensive, most beneficiaries paid the full cost out of pocket, and many simply went without, ending up in the hospital with cellulitis, non-healing surgical wounds, or progressive disabling lymphedema.

That changed on January 1, 2024.

How the Lymphedema Treatment Act became law

Decades of advocacy

• Founded around 2009 to 2010, the Lymphedema Advocacy Group organized a multi-year grassroots and legislative campaign
• The bill was introduced in successive Congresses
• Backed by cancer survivor organizations (Susan G. Komen, breast cancer advocacy networks, gynecologic cancer organizations, melanoma research foundations)
• Backed by professional organizations (APTA, AOTA, ASHA, the National Lymphedema Network, and LE&RN, the Lymphatic Education and Research Network)
• Built bipartisan congressional support

Enactment

• Enacted as Section 4133 of the Consolidated Appropriations Act, 2023 (Public Law 117-328)
• Signed December 29, 2022 by President Biden
• Division FF, Title IV, Subtitle D, Section 4133 is the Lymphedema Treatment Act
• Effective date: January 1, 20241

Statutory text

• Section 1861(s)(2)(JJ) of the Social Security Act added lymphedema compression treatment items as a covered Part B service category
• Section 1861(iii) of the Social Security Act is the definitional provision specifying the items covered

CMS implementation

• CMS implemented the benefit through the CY 2024 Home Health Prospective Payment System Final Rule (88 FR 77676, published November 13, 2023), the CMS lymphedema compression items program guidance, and follow-on instructions
• Despite the "HH PPS" title, the rule carried LTA implementation because it was the available regulatory vehicle for the January 1, 2024 effective date
• Established HCPCS codes, frequency limits, standard written order requirements, and supplier enrollment requirements

What lymphedema is, and why compression matters

Definition

Lymphedema is the abnormal accumulation of protein-rich fluid in tissues due to impaired lymphatic drainage. It typically affects an extremity (arm or leg) but can affect the trunk, head, neck, breast, or genitals.

Primary lymphedema

• Genetic or developmental abnormality of the lymphatic system
• May present at birth, during puberty, or later in life
• Examples: Milroy disease, Meige disease, lymphedema-distichiasis syndrome

Secondary lymphedema

• Results from damage to the lymphatic system
• Most common causes:
  • Cancer treatment: lymph node dissection, radiation
  • Breast cancer: especially axillary node dissection
  • Gynecologic cancers: pelvic node dissection
  • Prostate cancer: pelvic radiation
  • Melanoma: sentinel or regional node procedures
  • Head and neck cancer: cervical node dissection
• Filariasis (parasitic infection, rare in the U.S., common in some tropical countries)
• Post-surgical (non-cancer surgeries affecting lymphatic flow)
• Post-traumatic (severe injury)
• Chronic venous insufficiency with secondary lymphedema

Why compression matters

Compression supports impaired lymphatic return, prevents fluid accumulation, and helps prevent cellulitis (a common, dangerous complication) and skin breakdown. It maintains function and quality of life, and for most patients it is required daily and lifelong.

What Medicare did not cover before 2024

What was covered (and still is)

• Outpatient therapy under Part B
• Complete Decongestive Therapy (CDT) by qualified therapists (PT or OT with lymphedema-therapist certification)
• Includes manual lymphatic drainage, compression bandaging instruction, exercise, skin care, and self-management training
• Subject to the KX modifier threshold framework that followed the Bipartisan Budget Act of 2018 repeal of the hard therapy caps
• Substantive coverage under Section 1862(a)(1)(A) and the Jimmo v. Sebelius settlement

What was NOT covered before January 1, 2024

• Daytime compression garments
• Nighttime compression garments
• Custom-fit garments
• Compression bandaging systems for home use
• Adjustable Velcro compression wraps
• Donning and doffing aids and accessories

The durable-medical-equipment definition problem

Section 1861(n) of the Social Security Act historically defined durable medical equipment as equipment that withstands repeated use, is primarily used to serve a medical purpose, is generally not useful in the absence of illness or injury, and is appropriate for use in the home. Compression garments, being soft goods with a limited useful lifetime (typically replaced roughly every 6 months for daily use), did not fit the "withstands repeated use" durability concept. They were classified as supplies, not DME, and Medicare generally did not cover them without specific statutory authorization. The Lymphedema Treatment Act solved this by creating a new benefit category specifically for lymphedema compression treatment items.1

What the Lymphedema Treatment Act covers

CMS implementation specifies covered items in several categories.

Daytime compression garments

• Standard-fit (off-the-shelf) options
• Custom-fit when medical necessity supports it
• Medicare allows 3 daytime garments or wraps per affected body area every 6 months1

Nighttime compression garments

• Designed for lower-compression overnight use
• Medicare allows 2 nighttime garments per affected body area every 24 months1

Compression bandaging systems and supplies

• For the intensive phase of CDT
• Short-stretch bandages, padding, foam, gauze
• Higher quantity during the intensive phase, ongoing supply during maintenance

Gradient compression wraps with adjustable straps (Velcro-closure devices)

• Adjustable Velcro devices (for example, FarrowWrap and CircAid-style wraps)
• Useful when standard garments are difficult to don and doff
• Patient-specific medical-necessity documentation required

Accessories

• Donning and doffing aids
• Fillers, foam pieces, padding
• Bandage retainers

Frequency limits and replacement

CMS set frequency and replacement standards per item category, with additional items available for lost, stolen, or irreparably damaged garments, and for bilateral or rapidly progressive disease when documentation supports it.1

HCPCS codes for compression items

CMS established HCPCS Level II codes specifically for LTA-covered items, published in transmittals and the HCPCS code set. Suppliers bill using these codes, and the DME MAC processes claims accordingly.

What order and documentation you need

The standard written order (SWO)

A standard written order must include the beneficiary's name, the order date, a description of the item, the quantity (if applicable), and the treating practitioner's name, NPI, and signature. It may be written by a physician, nurse practitioner, physician assistant, or clinical nurse specialist, to the extent authorized under state law, and is required before delivery for most items.1

Documentation supporting medical necessity

Beyond the SWO, the record should show:

1. Lymphedema diagnosis documented in the medical record (ICD-10-CM codes such as I89.0 lymphedema not elsewhere classified, I97.2 postmastectomy lymphedema syndrome, or Q82.0 hereditary lymphedema)
2. Clinical evaluation establishing the affected body parts, severity, and functional impact
3. Plan of care for ongoing lymphedema management
4. Clinical justification for the item type (standard vs custom, daytime vs nighttime, adjustable wrap, bandaging system)
5. Treating-practitioner involvement confirming medical necessity

A certified lymphedema therapist's evaluation can support the SWO documentation but does not replace the SWO itself, which must come from a qualifying practitioner.

What Medicare lymphedema coverage costs in Georgia

After the annual Part B deductible, Medicare pays 80% of the lesser of the supplier's charge or the national DMEPOS fee-schedule amount, and you pay the remaining 20% coinsurance.1 Several programs can cover that share:

• Medigap (Medicare Supplement) may cover the coinsurance
• Medicaid for dual eligibles may cover cost-sharing
• Medicare Savings Programs (QMB, SLMB, QI) may cover the Part B premium and, for QMB, cost-sharing
• Medicare Advantage plans must cover the benefit but may set different cost-sharing and network rules

How Georgia claims are processed: CGS Administrators, the DME MAC

Georgia DMEPOS claims, including LTA-covered compression items, are processed by CGS Administrators as the DME MAC for Jurisdiction C, which covers Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, Puerto Rico, South Carolina, Tennessee, Texas, the U.S. Virgin Islands, Virginia, and West Virginia.2

Palmetto GBA serves as the Part A/B MAC for Jurisdiction J, including Georgia, processing outpatient therapy claims.2 DME MAC jurisdictions are organized separately from Part A/B MAC jurisdictions, so a Georgia lymphedema patient's compression items and CDT therapy are billed to two different contractors.

CGS Administrators processes compression-item claims, issues redeterminations on appeal, applies CMS coverage and documentation guidance, provides supplier education, and maintains the relevant local coverage articles.

How the LTA works with outpatient CDT therapy

Complete Decongestive Therapy (CDT) is the gold-standard manual treatment for lymphedema.

Phases

1. Intensive phase (typically 2 to 6 weeks): manual lymphatic drainage, multilayered compression bandaging, exercise, skin care
2. Maintenance phase (lifelong): self-care including compression garments, self-drainage, exercise, skin care, and periodic therapist follow-up

Coverage

• Outpatient PT or OT with a certified lymphedema therapist delivers the manual treatment under the Part B outpatient therapy benefit
• Subject to the post-BBA 2018 KX modifier threshold framework: for CY2026, $2,480 for physical therapy and speech-language pathology combined, and $2,480 for occupational therapy3
• The LTA covers the compression items used during and after the intensive phase

Certified lymphedema therapists

A Certified Lymphedema Therapist (CLT) credential is conferred through the Lymphology Association of North America (LANA) or other CLT programs, typically after 135 or more hours of specialized training.

Where to find lymphedema care in Georgia

Hospital-based cancer programs with lymphedema services

• Emory Healthcare: Winship Cancer Institute lymphedema program; outpatient PT and OT with CLT therapists
• Wellstar Health System: multi-site oncology rehabilitation including lymphedema
• Piedmont Healthcare: Piedmont Cancer Institute lymphedema services
• Northside Hospital: Northside Cancer Institute, one of the largest community cancer programs in the U.S., with extensive lymphedema services
• Augusta University Medical Center: Georgia Cancer Center
• Memorial Health Savannah: coastal Georgia
• Phoebe Putney: southwest Georgia
• Atrium Health Navicent: Macon and central Georgia
• Northeast Georgia Health System: Gainesville and northeast Georgia

DMEPOS suppliers

• National DMEPOS suppliers (for example, Edgepark and Byram)
• Specialty lymphedema-product suppliers with broad geographic reach
• Local Georgia DMEPOS suppliers
• Manufacturer programs (Juzo, Mediven, Sigvaris, Jobst, Solaris, and others)

Worked examples: how coverage plays out

Example #1: Fulton County, breast-cancer secondary lymphedema

Patient: A 70-year-old Fulton County resident, 18 months after a right total mastectomy with axillary lymph node dissection and radiation, with mild-to-moderate right-arm lymphedema diagnosed during follow-up at Emory. Before the LTA: The beneficiary paid out of pocket for daytime garments across multiple replacement cycles a year, a recurring cost Medicare did not share. After the LTA: The treating oncologist completes the SWO; the certified lymphedema therapist at Emory evaluates and recommends daytime garments, a nighttime garment, and bandaging supply for a 4-week intensive phase. A DMEPOS supplier bills CGS Administrators using the LTA HCPCS codes. Medicare pays 80% of the allowed amount after the Part B deductible, and Medigap covers the 20% coinsurance.1 Outcome: The out-of-pocket garment cost drops to routine Medicare cost-sharing.

Example #2: DeKalb County, gynecologic-cancer survivor

Patient: A 75-year-old DeKalb County resident, 3 years after a hysterectomy with pelvic lymph node dissection and radiation for endometrial cancer, with bilateral lower-extremity lymphedema. Care plan: Wellstar gyn-onc follow-up; therapist-led outpatient PT for a 4-week intensive CDT course, plus LTA compression coverage for bilateral leg garments (daytime and nighttime) and ongoing maintenance supplies. Documentation: Lymphedema diagnosis (I97.2), bilateral clinical findings, therapist evaluation, and an SWO from the Wellstar gyn-onc.

Example #3: Worth County, primary lymphedema and rural access

Patient: A 72-year-old Worth County (rural southwest Georgia) resident with lifelong primary lymphedema (Meige disease). Setting: Phoebe Putney outpatient rehabilitation, with limited but accessible rural CLT availability. Care plan: Annual therapist follow-up and LTA-covered compression garments for bilateral leg maintenance. Access considerations: A mail-order DMEPOS supplier furnishes the items, the local primary-care provider completes the SWO, and Phoebe Putney provides the clinical evaluation.

Example #4: Hall County, a denied claim on appeal

Patient: A 67-year-old Hall County resident with lymphedema from a melanoma sentinel-node procedure, whose compression-garment claim was denied citing insufficient documentation. Appeal:

1. Redetermination to CGS Administrators with supplemented documentation: the lymphedema diagnosis code, the therapist evaluation, a complete SWO, and the treating provider's clinical note
2. Reconsideration by a Qualified Independent Contractor if the redetermination upholds the denial
3. Administrative Law Judge hearing if needed Outcome: Comprehensive documentation typically resolves the denial at redetermination.

The scenarios above are hypothetical and illustrative. Actual coverage depends on your diagnosis, your documentation, and your specific plan.

Best practices for Georgia providers

1. Educate oncologists, gyn-oncs, urologists, surgeons, and PCPs so SWOs are issued promptly after diagnosis
2. Build referral workflows to certified lymphedema therapists and DMEPOS suppliers
3. Document the lymphedema diagnosis with appropriate ICD-10-CM codes
4. Complete SWOs comprehensively, with every required element
5. Coordinate therapist evaluations to support medical necessity
6. Use the correct HCPCS codes per CMS guidance
7. Educate beneficiaries on the benefit and its frequency limits
8. Track replacement schedules to support frequency-justified claims
9. Issue an ABN when a specific item is expected to be denied
10. Coordinate compression-item use with intensive CDT outpatient therapy

Common compliance and billing pitfalls

1. An incomplete or missing SWO, the leading cause of denial
2. Lymphedema diagnosis not documented in the medical record
3. HCPCS code errors, such as the wrong code for a specific item
4. Frequency over the limit without medical-necessity justification
5. Custom-fit billed without justification when standard would have sufficed
6. Inadequate clinical-evaluation documentation
7. Confusion between LTA-covered items and traditional DMEPOS, which use different code sets and rules
8. Confusion about which MAC processes claims: CGS Administrators for compression items, Palmetto GBA for outpatient therapy
9. Coordination gaps between the therapist, oncologist, PCP, and DMEPOS supplier
10. Beneficiary self-purchase where coverage is available but goes unused for lack of awareness

Where to get help in Georgia

Learn More

Find personalized help navigating Medicare lymphedema compression coverage in Georgia at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.