Providers get crash course on lymphedema rules

YARMOUTH, Maine – It’s a “time of learning” for providers, as they navigate providing compression therapy garments for Medicare beneficiaries with lymphedema, say industry stakeholders. 

CMS in November issued a final rule that expanded coverage to include compression garments and in December the agency published a related fee schedule. 

“Now people are trying to figure out how to transact business to support these patients who finally have access to these products,” said Eric Johnson, director of commercial development, Health and Medical Solutions at Essity. “It’s a time of learning and testing a little with the DME MACs so people can understand exactly how to do this.” 

The Lymphedema Treatment Act became law as part of an omnibus bill that was passed by Congress in late 2022, setting the stage for CMS to expand coverage. 

The coverage clearly outlines covered garments and frequency limits, but there is, at press time, still no local coverage determination to follow, Johnson says. 

“The good news is that the majority of these DMEs have tons of experience in dealing with the commercial payers,” he said. “They know exactly what (those payers required), so they are providing the same types of information to support that claim.” 

Still, providers are taking advantage of education being offered by companies like Essity, as well as Noridian and other industry groups, Johnson says. 

“There’s a lot of opportunities to engage with industry leaders in different areas,” he said. “We’re also watching to see if there are any gaps in the delivery of products and services and wherever we need to lean in, we will.” 

With nearly 10 million Americans suffering from lymphedema and lymphatic diseases, according to the Lymphedema Network, stakeholders say they expect to see an increase in providers offering compression therapy. A webinar that the Board of Certification/Accreditation hosted in January, in conjunction with the launch of its new lymphedema/compression accreditation, drew nearly 500 registrants, says Matt Gruskin, COO. 

“There is a significant demand for education related to the LTA,” he said. “We have had conversations with many owners of lymphedema/compression therapy clinics and other treatment facilities who are interested in entering the DMEPOS industry as a supplier so that they can provide more comprehensive care to their current and future patients.”