Lymphedema Garments and Compression

This page is for people with lymphedema, and for the caregivers who help them. It explains how compression garments work, which kinds to ask about, what Medicare covers, and when to call for help.

Lymphedema is swelling that builds up when lymph fluid cannot drain normally. After cancer surgery or radiation, lymph nodes and lymph vessels may be removed or scarred. Fluid then collects in an arm, a leg, the chest wall, the trunk, or the head and neck.

Compression does not cure that. NCI says it gives a barrier that helps the muscles pump fluid up the lymph system. NCI's patient advice is to wear garments daily when you are up and moving, and at night as your therapist advises.

The National Cancer Institute describes complete decongestive therapy, or CDT, in two phases.

Phase 1 is reduction. It uses skin and wound care, exercise, manual lymphatic drainage, and multilayer compression bandages. These are done daily for an average of 15 days. This phase uses bandages, not garments.

Phase 2 is maintenance. Skin and wound care, exercise, manual lymphatic drainage as needed, and compression garments. Ask your therapist when you should be measured for a garment.

NCI describes a certified lymphedema therapist, or CLT, as a physical or occupational therapist trained to treat lymphedema. Ask for a referral by that title.

NCI treats these two kinds of garment differently.

NCI's advice depends on the stage of the lymphedema. The staging used is the International Society of Lymphology system:

• Stage 0 means lymph transport is already impaired with no visible swelling.
• Stage I can go away on its own. It usually shows pitting swelling (a dent stays after pressing) and heaviness.
• Stage II tissue feels spongy without pitting. Scarring can make the limb harden and grow.
• Stage III is the most advanced stage. Swelling is mostly from extra fat, so there is no pitting.

Circular knit garments deliver more pressure at the narrow end of the garment. NCI notes it suits venous insufficiency better than it suits lymphedema.

Flat knit garments are inelastic. They apply pressure evenly over a large area. NCI states that flat knit inelastic garments work better than elastic compression in both the reduction and the maintenance phase of stage II and stage III lymphedema.

Elastic garments still have a place. NCI lists them for stage I lymphedema, and for lymphedema that has been brought back to stage II after complete decongestive therapy.

Ask your therapist whether you need a night garment. Medicare lists nighttime garments as their own category, with their own limits (see below).

An intermittent pneumatic compression pump uses inflating chambers in a sleeve. NCI records a specific caution here. There is a theoretical concern that pressures above 60 mm Hg, and long-term use, may injure lymphatic vessels. If a pump is part of your plan, ask what pressure setting is programmed and write it down.

This changed recently, and many people still assume garments are out of pocket. Section 4133 of the Consolidated Appropriations Act, 2023 created a Medicare benefit for lymphedema compression treatment items. It took effect January 1, 2024.

Covered categories include:

• Standard daytime gradient compression garments
• Custom daytime garments
• Nighttime garments
• Gradient compression wraps
• Compression bandaging systems and supplies
• Accessories such as zippers, linings, paddings, or fillers

The quantity limits are specific:

• Three daytime gradient compression garments or wraps per affected body part, once every 6 months
• Two nighttime garments per affected extremity, once every 2 years
• Both a daytime and a nighttime garment may be billed for the same body part

Claims above those limits are denied unless a replacement is needed. That means medical need changed, or an item was lost, stolen, or damaged beyond repair. Suppliers bill those with the RA modifier.

Cost is not zero. The Part B deductible and coinsurance apply. Medicare pays 80 percent of the lesser of the supplier's actual charge or the national DMEPOS fee schedule amount.

Ask what numbers are being tracked. NCI cites two common yardsticks for the arm. A circumference difference of 2 cm or more at any single point, compared with the unaffected arm, is considered clinically meaningful by some experts. A volume difference of 200 mL or more between arms is the usual cutoff.

Keep your own tape measurements with dates. A garment that has stretched out will show up as creeping numbers before it shows up as an obvious problem.

NCI's skin rules for a limb at risk are concrete. Wear gloves for cooking and gardening. Use lotion so skin does not crack, since cracks let bacteria in. Ask your doctor about antibacterial ointment for any burn or cut. Wear loose clothing with no tight bands. Do not carry a handbag on the affected arm. Do not let anyone take blood pressure on that limb. Avoid extreme heat and sun exposure.

For caregivers, the useful jobs are steady ones. Help with donning, which is the hardest part for a stiff shoulder. Check the skin under the garment every evening. Track the reorder dates against the Medicare windows above.

Cellulitis is a skin infection that moves fast in a lymphedematous limb. NCI warns that untreated cellulitis can become life-threatening.

Call 911 or go to an emergency department if the redness spreads visibly over hours. Also call 911 or go if it comes with shaking chills, confusion, slurred speech, a pounding heart, breathlessness, or barely any urine. That picture can mean sepsis. It needs emergency care, not an appointment. Do not drive yourself.

Otherwise, call your care team right away, at any hour, for:

• Redness, warmth, tenderness, or pain in the swollen area
• Fever along with any of the above

MedlinePlus says to contact your provider right away for signs of cellulitis (MedlinePlus).

Call the same day for:

• A new 2 cm or greater jump in circumference at a point you usually track
• Numbness, tingling, blue or white fingers or toes, or a garment that leaves deep grooves in the skin

Do not put a compression garment back on a limb that has new spreading redness until the team says it is safe.

https://www.cancer.gov/about-cancer/treatment/side-effects/lymphedema/lymphedema-hp-pdq

https://www.cancer.gov/about-cancer/treatment/side-effects/lymphedema/lymphedema-pdq

https://www.cms.gov/files/document/mm13286-lymphedema-compression-treatment-items-implementation.pdf

https://www.medicare.gov/coverage/lymphedema-compression-treatment-items