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 new Medicare benefit. After your Part B deductible, you pay 20% of the Medicare-approved amount when your supplier is enrolled in Medicare and accepts assignment.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.

Before 2024, Medicare Part B's outpatient therapy benefit could pay a physical or occupational therapist to treat lymphedema. But Medicare had no benefit for the compression garments and bandaging systems many patients wear every day.1

That changed on January 1, 2024.

How the Lymphedema Treatment Act became law

Enactment

• Enacted as Section 4133 of the Consolidated Appropriations Act, 2023 (H.R.2617, Public Law 117-328)
• Effective date: January 1, 20241

Statutory text

• Section 1861(s)(2)(JJ) of the Social Security Act defines lymphedema compression treatment items as a Part B benefit category, and Medicare regulations at 42 CFR 410.36(a)(4) define it further
• Section 1861(mmm)(3) of the Act requires that the items be prescribed by a physician or another qualifying practitioner1

CMS implementation

• CMS implemented the benefit through the CY 2024 Home Health Prospective Payment System final rule (88 FR 77874), which "implements the new Part B benefit for lymphedema compression treatment items," and through its lymphedema compression items program guidance1
• The replacement and frequency limits are described in section 145 of chapter 15 of the Medicare Benefit Policy Manual (CMS Pub. 100-2)1

Who qualifies: primary and secondary lymphedema

The coverage condition is a lymphedema diagnosis, not a particular cause. Primary lymphedema you have lived with since childhood and secondary lymphedema that followed cancer surgery or radiation are both covered when the items are prescribed by a qualifying practitioner, furnished by an enrolled DMEPOS supplier, and found reasonable and necessary for you.1

What Medicare did not cover before 2024

What was covered (and still is)

• Outpatient therapy under Part B
• Complete Decongestive Therapy (CDT) delivered by a physical or occupational therapist
• Subject to the KX modifier threshold framework that followed the Bipartisan Budget Act of 2018 repeal of the hard therapy caps3
• Under the Jimmo v. Sebelius settlement, outpatient therapy coverage turns on your need for skilled care, not on whether you are expected to improve4

What was NOT covered before January 1, 2024

• Daytime compression garments
• Nighttime compression garments
• Custom-fit garments
• Compression bandaging systems for home use
• Gradient compression wraps with adjustable straps
• Donning and doffing aids and accessories1

The durable-medical-equipment definition problem

Medicare defines durable medical equipment as equipment that can withstand repeated use, is used for a medical reason, is typically only useful to someone who is sick or injured, is used in your home, and is expected to last at least 3 years.5 Rather than treat compression garments as DME, the Lymphedema Treatment Act created a separate Part B benefit category 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 garments, uniquely sized and shaped to the exact dimensions of the affected limb or body part
• Medicare pays for 3 daytime garments per affected body part every 6 months1

Nighttime compression garments

• Offer a different level of compression than daytime garments
• Medicare pays for 2 nighttime garments per affected body part every 2 years1

Compression bandaging systems and supplies

• Covered during both the initial decongestion phase and the maintenance phase of treatment1

Gradient compression wraps with adjustable straps

• Paid only when the DME MAC finds them reasonable and necessary for you1

Accessories

• Aids for putting items on and taking them off, such as lower limb butlers or foot slippers
• Fillers, lining, padding, and zippers1

Frequency limits and replacement

Because the limits apply per affected body part, a person with lymphedema in both legs counts each leg separately. Medicare also pays for items as needed to replace lost, stolen, or irreparably damaged items, or when your condition changes, such as a change in limb size.1

What order and documentation you need

The prescription

The items must be prescribed by a physician, or by a physician assistant, nurse practitioner, or clinical nurse specialist to the extent state law authorizes, and furnished by a supplier enrolled in Medicare as a DMEPOS supplier. The conditions of payment for other medical equipment orders also apply to these items.1

Documentation supporting medical necessity

The DME MAC pays only for items it finds reasonable and necessary for you, so it helps when the record shows:1

1. Lymphedema diagnosis documented in the medical record
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 lymphedema therapist's evaluation can support the documentation but does not replace the prescription itself, which must come from a qualifying practitioner.1

What Medicare lymphedema coverage costs in Georgia

After the annual Part B deductible ($283 in 2026), you pay 20% of the Medicare-approved amount and Medicare pays its share of that amount. The approved amount applies when the supplier accepts assignment, so confirm before you order that the supplier is an enrolled DMEPOS supplier and accepts assignment. The cost of teaching you to put the garment on and take it off is included in Medicare's bundled payment to the supplier, so Medicare cannot pay for that training separately under the physician fee schedule.1 Several programs can help with your share:

• Medigap (Medicare Supplement): depending on the plan letter, a policy may pay some or all of the Part B coinsurance6
• Medicaid for dual eligibles: Medicaid pays after Medicare and can cover Medicare premiums and cost-sharing7
• Medicare Savings Programs: in Georgia, QMB pays Medicare premiums, deductibles, and coinsurance, while SLMB and QI pay only the Part B premium8
• Medicare Advantage: plans must cover the Part B services Original Medicare covers, but may use networks and require prior authorization9

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.

If a compression-item claim is denied, the first level of appeal, a redetermination, is decided by the MAC that processed it, here CGS Administrators. The second level goes to a Qualified Independent Contractor that took no part in the first decision.2 Contractors change by procurement cycle, so confirm the current one on the CMS "Who are the MACs" page before you file.2

How the LTA works with outpatient CDT therapy

The LTA benefit follows the two phases of Complete Decongestive Therapy (CDT): compression bandaging systems and supplies are covered during the initial decongestion phase and during the maintenance phase that follows.1

Coverage

• A lymphedema-trained physical or occupational therapist delivers the hands-on 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 initial decongestion phase1

Where to find lymphedema care in Georgia

Therapy

Ask your oncology team or primary care provider to refer you to an outpatient physical or occupational therapist who treats lymphedema, and ask whether the therapist bills Medicare Part B.

Suppliers

Any supplier you use, whether a local Georgia shop or a mail-order company, must be enrolled in Medicare as a DMEPOS supplier for Medicare to pay at all. Ask whether it accepts assignment before you order.1

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 an Atlanta cancer center. 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 writes the prescription; a lymphedema therapist evaluates and recommends daytime garments, a nighttime garment, and bandaging supply for a 4-week intensive phase. An enrolled DMEPOS supplier that accepts assignment bills CGS Administrators. After the Part B deductible, she owes 20% of the Medicare-approved amount, and in this example her Medigap policy pays that 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: Gynecologic oncology 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, bilateral clinical findings, therapist evaluation, and a prescription from the gynecologic oncologist. Because the limits run per affected body part, each leg counts separately.1

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: Outpatient rehabilitation at a regional hospital in southwest Georgia. Care plan: Annual therapist follow-up and LTA-covered compression garments for bilateral leg maintenance. Access considerations: A Medicare-enrolled mail-order DMEPOS supplier furnishes the items, the local primary-care provider writes the prescription, and the regional hospital's therapists provide 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 prescription, 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 needed10 Outcome: In this example, the added documentation 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 prescriptions are issued promptly after diagnosis
2. Build referral workflows to certified lymphedema therapists and DMEPOS suppliers
3. Document the lymphedema diagnosis in the medical record
4. Complete prescriptions fully, 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 prescription
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 other DMEPOS, which fall under a separate benefit category
8. Confusion about which MAC processes claims: CGS Administrators for compression items, Palmetto GBA for outpatient therapy2
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.