“The goal of lymphedema treatment centers on controlling limb swelling and minimizing complications.”
– National Cancer Institute
Under current Medicare policy, lymphedema patients have coverage for Manual Lymphatic Drainage (MLD), performed by a qualified Medicare provider such as a physical or occupational therapist, and, when certain conditions are satisfied, a pneumatic compression pump. The function of both of these treatment modalities is to reduce the volume of stagnant lymph fluid in the affected body part or parts.
The function of compression is to maintain the affected body part in its reduced state and prevent it from swelling further. Without the use of compression garments and/or the other compression supplies outlined in the Lymphedema Treatment Act, MLD and lymphedema pumps provide no lasting benefit and do not enable the patient to maintain their condition.
Medicare does not recognize and acknowledge the necessary role compression plays in the treatment of lymphedema.
Lymphedema pumps, if prescribed, may be covered by Medicare (per National Coverage Determination 280.6) after “a four-week trial of conservative therapy” has shown little or no benefit. This “conservative therapy” must include the “use of an appropriate compression bandage system or compression garment”. The Decision Summary of the Decision Memo for Lymphedema Pumps (CAG 00016N) states providers should, “Encourage patients to use compression garments between pump sessions to prevent reaccumulation of fluid”.
Pumps are generally used for an hour a day. A person cannot perform most any activity of daily living while using the pump. The compression sleeve that comes with a pump is far different from the compression garments and other compression supplies that must be worn continuously to prevent fluid reaccumulation.
The Lymphedema Treatment Act will close the unintended gap in coverage that prevents Medicare beneficiaries from accessing these medically necessary, doctor prescribed compression supplies, which are the cornerstone of the standard of care for lymphedema.
Source
The Function of Compression and Why Current Medicare Coverage of Lymphedema Treatment is Inadequate. LymphedemaTreatmentAct.org, lymphedematreatmentact.org/wp-content/uploads/2018/02/Lymphedema-Treatment-Act-HR930_S497.pdf.
