Since the launch of the Lymphedema Treatment Act (LTA) on January 1, 2024, Compression Care has carefully evaluated the best ways to process Medicare claims for compression garments. Our team has worked diligently to understand how the policy functions in action to ensure the best path for implementation.
Our latest update is a significant change to our claims policy: effective immediately, we have eased our Medicare claims policy even further. As a result, garments with modifications are now being billed on assignment. That means patients no longer have to pay in full upfront for these garments; they’ll only be responsible for any remaining deductible and co-insurance (often covered by a supplement or secondary). Modifications include therapeutic additions, such as silver patches, Elbow Darts, silicone stoppers, etc.
In other words, these garments now bill just like anything else.
Further Explanation of Compression Care’s Medicare Claims Policy:
Medicare Standard vs. Upgraded Garments
We have identified the types of compression garments that can be dispensed within the Medicare standard. Compression Care is providing you with an exclusive Medicare Quick Reference Guide, which breaks down these garment types by manufacturer and specific garment. As you make recommendations for your Medicare patients, this guide will help you refer patients to garments that qualify and identify garments that will be considered upgrades from the Medicare standard because of added features.
Upgraded Garments ~ Garments with features beyond Medicare Standard
For garments that have upgraded features, including print patterns and dyed colors, Compression Care will continue to file Non-Assignment claims on behalf of the patient. We will also file Non-Assignment claims for garments that fall out of the Medicare allowable. This means the patient will pay in full up front, and Compression Care will file the claim for Medicare to reimburse the Medicare allowable amount directly to the patient.
Modified Garments Beyond Medicare Standard
By easing our Medicare claims policy, non-standard Medicare garments or garments with modifications are now being billed on assignment. That means patients no longer have to pay in full upfront for these garments; they’ll only be responsible for any remaining deductible and co-insurance (often covered by a supplement or secondary). These non-standard garments are now billed like any other standard garment.
Urgent Updates Regarding Medicare Advantage Plans (MAPs)
Details regarding traditional Medicare reimbursement are becoming more apparent. However, adoption by many Medicare Advantage Plans (MAPs) still remains fluid. We are working with all major carriers with MAPs to determine when and how they will adopt these new codes, and the specifics of their reimbursement schedules. We are now accepting MAPS from the following carriers:
- Aetna
- Humana
- CIGNA
For all other MAPs, please request a benefits check because it may or may not be covered yet.
Our New Medicare Quick Reference Guide Can Help Save You Time
Download our new Medicare Quick Reference Guide to save yourself time and hassle. We’ve done all the research on Medicare coverage with the LTA on your behalf and compiled it in one location for your convenience. This document lays out the coverage for standard and non-standard compression garments for lymphedema, a breakdown of billing by Medicare plan type, diagnosis codes, and documentation requirements.
How to Get the Fastest Turnaround for Processing Garment Orders
For patients with traditional Medicare, no benefits check is necessary. For the fastest turnaround service, please send us all of the following information at once:
- Patient Demographics (Including Insurance Card)
- Signed Physician Order (Rx) or Physician-Signed Plan of Care
- Detailed Garment Order
- Fabric Brand
- Compression Class
- Style
- Size
- Color
- Qty (3 Day/Body Part, 2 Night/Body Part)
- Shipping Instructions (Therapist Clinic/Patient Home)
The more information you can provide us, the better. However, you can’t give us too much information. The above inclusions are minimum requirements; include anything else you have. If in doubt, send it out!
Once we have received all the required information and the patient is at 100% with insurance, we will place the order immediately. If the patient owes anything, we won’t order without checking for patient approval.
Stay Tuned for More Updates!
As the year progresses and we understand more about how Medicare’s coverage of compression garments functions under the Lymphedema Treatment Act, we will continue to update this page with the most important news and information. Helping you and your patients utilize these new Medicare benefits is an integral part of our ongoing commitment to making high-quality compression care more accessible, affordable, and convenient – no matter where you live!
Please don’t hesitate to reach out if you have any questions about LTA implementation or anything else. Thank you for trusting us to care for your patients!
Contact Information
Joshua Perkins
Chief Operating Officer, Compression Care
Email: [email protected] | Phone: (629) 230-7774
Book a meeting: Q&A with Joshua