Lymphedema Act expands access, but coverage gap remains

The Lymphedema Treatment Act (LTA) has opened the door for providers to expand services and reach more patients, but it might not go far enough. 

The law, which took effect Jan. 1, 2024, requires Medicare to cover compression garments, wraps and bandages, but not the footwear many patients need to stay mobile. 

Positive impact 

The act has had a measurable impact: Broadening access for a patient population whose care often involves complex medical histories and overlapping conditions. 

“(It's) had a positive impact on and brought increased attention to the need for proper documentation, patient evaluation and fitting processes related to compression garments,” said Matt Gruskin, MBA, BOCPD, CDME, COO of BOC. “We’ve seen a growing number of suppliers expand their services to meet these needs, which aligns with the act’s original intent.” 

Gruskin says BOC has worked with more than 500 facilities this year to add compression garment services. The patient base is large and growing, especially among cancer survivors and patients with comorbidities like obesity or chronic venous insufficiency. 

“This presents a broader opportunity for suppliers to address multiple needs within the same patient population,” he said. 

Diminished return? 

The lack of coverage for shoes, however, is a problem because mobility is key to getting the most out of lymphedema therapy and appropriate footwear often makes the difference, says Stephen O’Hare, president of Pedors Shoes. 

“Without appropriate, accommodative footwear that may also add some degree of compression, the results and benefits of the covered items may be somewhat diminished," he said. 

Pedors has long offered the XXXW 6E Classic MAX shoe that works for 70% of patients with lymphedema, but alongside the LTA rollout, the company introduced the Pedors Super MAX in a 10E XXXXXW width that works for most of the remaining 30%. 

“We have a shoe version ideal for PT and for outside of the home and an open-backed slide/slipper version for in and around the home that also works well for patients with a limited reach and range of motion,” said O’Hare.