Treatment of lymphedema

The Women's Health and Cancer Rights Act (WHRCA) requires coverage for the treatment of physical complications from mastectomy, including lymphedema. This may include:

• Compression lymphedema sleeves
• Elastic bandages and wraps associated treatment lymphedema
• Complex decongestive physiotherapy (CDP)
• Lymphedema pumps

Most health insurers consider lymphedema bandages and compression garments a type of “durable medical equipment” or “DME” and allow for coverage of a set number of compression garments per affected limb (i.e. arms or legs) with periodic replacements (every 6 months, for instance) as considered medically necessary.

WHRCA does not require 100% coverage by health insurance so copays, coinsurance and deductibles may apply. Coverage and out-of-pocket costs may vary with in-network versus out-of-network providers.

Medicare & Medicaid

Medicare and Medicaid are public programs that are not bound by the WHRCA. They have their own rules. Nationally, Medicare generally does not cover compression bandages and garments. However, many local Medicare jurisdictions have lymphedema treatment guidelines found either in a local coverage determination (LCD) on Physical Therapy and Rehabilitation, or in a special LCD on Complex Decongestive Therapy for Lymphedema. Medicaid coverage varies by state. 

If your health insurer will not cover your compression bandages or garments—or of the out-of-pocket costs present a challenge—ask your provider about lymphedema treatment resources.