Lymphedema Treatment Act Update
Published in
Women's Health
on May 20, 2025
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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- vgm
- women's health