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Lymphedema Care 

Patient & General Population Guide:
Insurance Coverage for Lymphedema Care: What You Need to Know

Living with lymphedema can feel overwhelming, especially when you learn that care requires daily supplies and specialized garments. The good news is that, starting in 2024, Medicare and many insurers now cover much of this care.

 

Understanding what is included, how the process works, and what steps you need to take can help you feel more confident and in control of your health (CMS, 2024; Lymphedema Advocacy Group, 2024).

Why this matters:

Managing lymphedema takes two key phases:

  • Reduction phase (Complete Decongestive Therapy / CDT): swelling is actively reduced using therapy, manual drainage, and special bandages.

  • Maintenance phase: swelling is kept down with fitted compression garments, nighttime devices, and sometimes pneumatic pumps.

 

Both phases are essential. Insurance now helps cover supplies and products, but the process can still be slow and confusing (CMS, 2024; Lymphedema Advocacy Group, 2024).

What Medicare Covers (as of Jan 2024):

Phase 1 – Reduction (CDT):

  • Short-stretch bandages, padding, liners, wraps (supplies now covered under Part B) (CMS, 2024).

  • Therapy visits (manual lymph drainage, exercise, education, bandaging) are covered under PT/OT benefits, though the number of visits is often limited (NCCN, 2025).

  • Frequency: Ideally daily bandaging, but insurance commonly allows only 2–3 sessions per week. Patients or caregivers may need to continue wrapping at home (ILF, 2020).

 

Phase 2 – Maintenance:

  • Daytime garments/wraps: Up to 3 per affected body part every 6 months.

  • Nighttime garments: Up to 2 per affected body part every 2 years.

  • Accessories: Donning/doffing aids, gloves, padding.

  • Pneumatic compression pumps: Covered if swelling does not improve after at least 4 weeks of standard care (CMS, 2024).

The Process Step-by-Step:

  1. Evaluation

    • Therapist evaluates swelling, skin, and function.

    • Covered under PT/OT insurance benefits (NCCN, 2025).​​​

  2. Ordering Reduction Supplies

    • Doctor (or NP/PA) prescribes bandages, padding, liners.

    • Supplies must come from a Medicare-enrolled DMEPOS supplier (CMS, 2024).

  3. Reduction of Swelling

    • Therapist applies multilayer bandaging and trains you or a caregiver in self-bandaging.

    • Ideally performed daily, but often reduced to several times/week depending on insurance coverage (ILF, 2020).

  4. Fitting

    • Once swelling is reduced, you are measured for garments.

    • Some therapists perform fittings, but often a certified fitter handles this step (Reich-Schupke, 2019).

  5. Ordering Maintenance Products

    • Doctor signs prescription for garments, nighttime products, and accessories.

    • Supplier submits claims to insurance (CMS, 2024).

  6. Claim & Delivery

    • Approval may take weeks to months depending on supplier availability.

    • Medicare covers 80%; patients pay 20% unless they have supplemental insurance (Medicare.gov, 2025).

  7. ​Ongoing Maintenance

    • Wear compression garments daily; follow up with therapist or fitter as needed.

    • Replacement schedule: 3 daytime garments every 6 months; 2 nighttime garments every 2 years (CMS, 2024).

Common Questions (FAQ):

  • Medicare Advantage: Same coverage as Medicare but often requires prior authorization and limits suppliers.

  • Medicaid: Varies by state—some cover both CDT supplies and garments, others only partial coverage (Lymphedema Advocacy Group, 2024).

  • Commercial insurance: Coverage often restricted to cancer-related cases. Pumps typically require proof that conservative therapy “failed” first (Anthem, 2025).

  • Real-life: Patients may face 1–3 month waits due to supplier shortages and documentation delays. Active follow-up by patients shortens delays (AOTA, 2023).

Non-Medicare Coverage & Real-Life Situations:

  • “Can I get custom garments?”

Yes. If your limb shape makes off-the-shelf garments unsuitable, your doctor can prescribe custom garments, but the prescription must explain why (Reich-Schupke, 2019).

  • “Why do I still have to pay something if Medicare covers it?”

Medicare Part B pays 80% of approved costs; patients are responsible for 20% unless they have a secondary plan (Medicare.gov, 2025).

  • “How long will it take to get my garments?”

Realistically, it may take 1–3 months due to supplier backlogs and paperwork (Lymphedema Advocacy Group, 2024). Following up frequently often speeds the process.

  • “Are the tools that help me put garments on (donning/doffing aids) covered?”

Yes, if prescribed and justified as medically necessary (CMS, 2024).

  • “What if I need a pump?”

Pumps are covered only after at least 4 weeks of conservative care (bandaging, garments, exercise) without sufficient improvement (CMS, 2024).

Be an Active Leader in Your Care

Patients who track their progress, keep copies of prescriptions, and follow up with suppliers and clinicians are more likely to avoid delays and maintain steady care (AOTA, 2023). Taking an active role is essential in long-term lymphedema management.

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Scientific References:

  • American Occupational Therapy Association. (2023). New lymphedema benefit increases patient access.

  • Anthem/Blue Cross. (2025). Compression devices for lymphedema policy.

  • Centers for Medicare & Medicaid Services. (2024). Lymphedema compression treatment items benefit.

  • International Lymphoedema Framework. (2020). Best practice for the management of lymphoedema.

  • Lymphedema Advocacy Group. (2024). Lymphedema Treatment Act implementation updates.

  • Medicare.gov. (2025). Your Medicare coverage: Lymphedema compression items.

  • National Comprehensive Cancer Network. (2025). Survivorship guidelines.

  • Reich-Schupke, S. (2019). Compression therapy: Indications and evidence.

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