Lymphedema Treatment Act Update

Published in Women's Health on May 20, 2025

Jeremy Stolz By Lindsay Ryback, Director of Lymphology & Phlebology, Thuasne

Lymphedema is a chronic swelling condition due to a damaged or impaired lymphatic system with one of critical components to care being compression therapy. Thanks to the efforts of the Lymphedema Advocacy Group (LAG), a patient-led grassroots organization, the Lymphedema Treatment Act was successfully enacted into federal law on December 23, 2022, following over 12 years of advocacy in Congress.

Starting January 1, 2024, this law introduced a new Medicare benefit category specifically for lymphedema compression supplies. This category encompasses various items such as daytime garments (either flat or circular knit), adjustable wraps, nighttime garments, and bandages. The rollout of this benefit included 78 new HCPCS codes designed to address the diverse needs of patients, as lymphedema can manifest anywhere on the body. Currently, coverage decisions are made individually for each claim by the DME Medicare Administrative Contractors (MACs), and there are no Local Coverage Determination (LCD) or National Coverage Determination (NCD) guidelines established at this time.

Applicable Diagnosis Codes

ICD-10 Codes	Description
I89.0	Lymphedema, not elsewhere classified
Q82.0	Hereditary Lymphedema
I97.2	Postmastectomy Lymphedema Syndrome
I97.89	Other postprocedural complications and disorders of the circulatory system, not elsewhere classified

Medicare Frequency Limitations

Product	Quantities and Timelines
Daytime	3 units per affected body part every 6 months
Nighttime	2 units per affected body part every 2 years
Accessories	Based on clinical need
Bandages	Based on clinical need. Both Phase 1 &2

Despite the introduction of numerous new codes, some gaps still needed attention. Starting April 1, 2025, five new HCPCS codes have been added, along with revisions to five existing HCPCS codes. Please refer to the charts below for detailed information.

New Lymphedema HCPCS Codes (as of April 1, 2025)

HCPCS	Long Description
A6515	Gradient compression wrap with adjustable straps, full leg, each, custom
A6516	Gradient compression wrap with adjustable straps, foot, each, custom
A6517	Gradient compression wrap with adjustable straps, below knee, each, custom
A6518	Gradient compression wrap with adjustable straps, arm, each, custom
A6611	Gradient compression wrap with adjustable straps, above knee, each, custom
A6519	Gradient compression garment, not otherwise specified, for nighttime use, each

Note: The fee schedule was not defined.

Revised Lymphedema HCPCS Codes (as of April 1, 2025)

HCPCS	Long Description	What Changed?
A6583	Gradient compression garment, not otherwise specified, for daytime use, each	Removed “30-50mmHg”
A6585	Gradient compression wrap with adjustable straps, above knee, each	Replaced “pressure” with “compression”
A6586	Gradient compression wrap with adjustable straps, full leg, each
A6587	Gradient compression wrap with adjustable straps, foot, each
A6588	Gradient compression wrap with adjustable straps, arm, each

We look forward to seeing you all at the VGM Heartland Conference in Waterloo, IA.

Be sure to come to our workshop “Understanding the Local DME Role in Lymphedema Care” on Wednesday, June 11, 2025, at 8 a.m. – and don't forget to stop by our Thuasne USA booth #211!

If your company is wondering how to enter the compression market or interested in making your compression business more profitable, we’d love to connect you with our clinical and sales teams. Contact me at lindsay.ryback@thuasneusa.com.

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