More of your patients are on Medicare Advantage, and their access to compression can look very different from patients on Original Medicare. This summary draws on a recent webinar from the Lymphedema Education & Awareness Project with attorneys from the Center for Medicare Advocacy (watch it on YouTube), and on the 2026 Coverage Report from the Lymphedema Advocacy Group.
Original Medicare: the baseline
Requirements: a lymphedema diagnosis, a detailed order for all compression items, and clinical notes supporting the need for each item, especially custom garments
Quantities per affected body part: 3 daytime garments every 6 months and 2 nighttime garments every 2 years. There is no set quantity limit on bandaging supplies and accessories.
The 2-year nighttime window starts on the first date of service, not the calendar year
No prior authorization and no brand exclusions, and coverage is the same for custom and standard garments
Replacement outside the normal frequency is for items that are lost, stolen or irreparably damaged, or for a change in the patient's condition. Normal wear and tear doesn't qualify.
Documentation: answer the "why"
There is still no LCD or NCD for lymphedema compression treatment items. The DME MACs review claims individually, starting from their joint publications (the FAQs and the correct coding and billing article). The diagnosis code gets the patient in the door. After that, approval depends on documentation that explains why the patient needs each item, quantity and fit. Clear notes on the "why" lead to approvals.
How Medicare Advantage can differ
Written lymphedema coverage policies are rare and hard to get
Prior authorization is common
Plans can exclude some brands
Each plan sets its own payment rates, and some pay below a supplier's cost
Networks can be narrow, and an in-network supplier may not carry the item prescribed
Plans may approve fewer garments than Original Medicare by denying quantities as not medically necessary
The Center for Medicare Advocacy's position is that Medicare Advantage plans can't set lower written quantity limits than Original Medicare, because they must cover what Original Medicare covers. In practice, the limits show up through medical-necessity reviews.
What the 2026 Coverage Report found
The Lymphedema Advocacy Group surveyed people with lymphedema from September 8 to October 19, 2026, and included 482 responses (194 Original Medicare, 144 Medicare Advantage). Results are patient-reported, not verified claims:
Original Medicare scored higher than Medicare Advantage on out-of-pocket costs (3.6 vs. 2.6 out of 5), replacements (3.2 vs. 2.8) and preferred brands (3.3 vs. 2.9)
53% of Original Medicare respondents reported enough suppliers who take their insurance, compared with 62% for Kaiser Permanente, 46% for Aetna/CVS, 43% for Blue Cross Blue Shield, 29% for UnitedHealthcare and 12% for Humana
Reported garment denials among Medicare Advantage members ranged from none (Kaiser Permanente) and 5% (Aetna/CVS) to 18% (Blue Cross Blue Shield) and 44% (UnitedHealthcare)
Many Medicare Advantage members didn't know their daytime or nighttime garment limits
How to help Medicare Advantage patients
Before enrollment: suggest patients ask the plan for a written policy, cost sharing (listed under durable medical equipment in the Summary of Benefits and Evidence of Coverage), quantity limits and a list of in-network suppliers. They can compare the plan's list with the Medicare.gov supplier directory under "Lymphedema compression treatment items."
If prior authorization or a claim is denied: help the patient appeal in writing. Cite the Original Medicare quantity limits and the plan's obligation to cover what Original Medicare covers. Include all supporting notes again at every appeal level. The presenters said beneficiaries who appeal win more often than not.
If no supplier will request approval: the patient can send the order directly to the plan and ask for an organization determination, which can then be appealed.
If the plan won't give a clear answer or has no supplier: the patient can file a grievance within 60 days. The plan must answer in writing within 30 days. Lack of a supplier may also be a network adequacy issue.
Report access problems: the Lymphedema Advocacy Group collects denials and coverage problems through its reporting form, and providers can use CMS's Medicare Advantage complaint form.
Patients in home health
Per the webinar, lymphedema compression treatment items stay separately billable for patients receiving home health care. They aren't bundled into the home health payment.
Let us handle the paperwork
Send the order and a recent progress note by fax or Parachute Health. We check the patient's plan in writing, request prior authorization when needed, and tell you right away if the notes need anything else. Call (800) 883-1549 with questions.
Sources: Comparing Medicare Plans: A Lymphedema Patient's Guide to Researching Coverage Options (Lymphedema Education & Awareness Project and Center for Medicare Advocacy); 2026 Coverage Report, Lymphedema Advocacy Group. General information only, not legal or billing advice.
