Does Medicaid Cover Lymphedema Therapy?

In this article...
  • Does Medicaid cover lymphedema therapy? Discover which lymphedema therapies are covered by Medicaid and Medicare and what to expect at a lymphedema clinic.

Lymphedema is a condition where lymphatic fluids don’t drain properly. It causes tissue swelling, often in the arms and legs, and can impact a person’s ability to move, cause skin changes and increase the risk of infection. It’s estimated that as many as 5 million Americans are impacted by the condition, which can be caused by certain congenital diseases or as a result of cancer or damage to the lymphatic system. There are a variety of techniques that can help reduce swelling, so it’s important to know whether Medicaid covers lymphedema therapy. 

Does Medicaid Cover Lymphedema Therapy?

Lymphedema therapy uses different techniques and equipment to reduce swelling in people who have lymphedema, including exercise, manual fluid drainage, compression through bandages and garments and lymphatic pumps. 

As Medicaid is administered by individual states, the exact coverage available always depends on your location. Some states do cover the cost of compression garments and may also cover manual lymphatic drainage performed by a physical or occupational therapist. It’s important to find therapists and compression garment vendors that accept Medicaid, but even then, it’s possible the costs may not be covered completely. Contact your local Medicaid program to find out Medicaid covers lymphedema therapy in your state.

Is Lymphedema Massage Covered by Medicare?

Medicare coverage for lymphedema therapy is limited. Benefits do include manual lymphatic drainage, which is also known as lymphedema massage. To be covered, it must be performed by a qualified Medicare provider, such as a physical or an occupational therapist. Medicare doesn’t cover compression garments but, in some cases, will cover a lymphedema pump if compression therapy doesn’t work. 

What Can I Expect at a Lymphedema Clinic?

Lymphedema clinics are specialized medical facilities that diagnose and treat lymphedema. Your first visit to a clinic will involve diagnosing the problem and developing a treatment plan. The therapist will generally ask about:

  • Your medical history
  • Any surgery you’ve had, especially if you had lymph nodes removed due to cancer
  • Symptoms such as heaviness, tingling and swelling
  • Anything that triggers symptoms
  • Pain you experience
  • Your personal history, including lifestyle, exercise, nutrition and weight

There will also be a physical examination where the therapist will look for changes in the skin and soft tissue of areas affected and take measurements of the parts of your body where you’re experiencing swelling. More tests may be ordered to rule out other possible causes of your symptoms. 

If lymphedema is determined to be the cause, your therapist will make a firm diagnosis and discuss treatment with you. They may start that treatment straight away with manual lymphatic drainage or compression bandages. In most cases, a follow-up appointment will be made so your treatment can continue. 

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