Lymphedema Physical Therapy and Compression Treatment

Lymphedema physical therapy

Introduction

This article provides important information for healthcare providers regarding Medicare coverage for lymphedema compression treatment items. Starting January 1, 2024, Medicare will pay for lymphedema compression treatment items for Medicare Part B patients. Read on to learn about what’s covered, how often Medicare pays for these items, eligibility requirements, and your responsibilities as a healthcare provider.

What’s Covered?

Medicare will pay for both standard and custom-fitted lymphedema compression treatment items for each affected body part. The covered items include:

  1. Compression garments: This includes garments for daytime and nighttime use, which offer different levels of compression.
  2. Compression bandaging systems and supplies: These are provided during the initial decongestion phase and maintenance phases of treatment.
  3. Gradient compression wraps with adjustable straps.
  4. Necessary accessories for gradient compression garments and wraps: This includes aids for putting on and taking off the items, fillers, lining, padding, and zippers.

How Often?

Medicare pays for compression garments as follows:

  • Daytime: 3 garments per affected body part every 6 months.
  • Nighttime: 2 garments per affected body part every 2 years.

Additionally, Medicare will also cover replacement items if the original items are lost, stolen, or irreparably damaged. If a patient’s condition changes, such as a change in limb size, Medicare will cover the necessary items as well.

Who’s Eligible?

To be eligible for Medicare coverage of lymphedema compression treatment items, the following criteria must be met:

  1. The patient must have Medicare Part B coverage. The annual Part B deductible and 20% coinsurance will apply.
  2. The patient must have lymphedema, which is a chronic condition causing swelling in the body’s tissues. The item must be primarily and customarily used to treat this condition.
  3. An authorized practitioner must prescribe the item.

Can I Furnish These Items?

To receive Medicare payment for furnishing lymphedema compression treatment items, you must be an enrolled DMEPOS (Durable Medical Equipment, Prosthetics, Orthotics, and Supplies) supplier. If you are enrolling in Medicare for the first time to supply these items, submit a letter stating this with your application. The CMS 855S form will be updated to include these items.

What Are My Responsibilities?

As a healthcare provider, you are responsible for all aspects of providing lymphedema compression treatment items, unless you have an arrangement with an external fitter to perform the services. Your responsibilities include:

  1. Taking measurements of the patient’s affected body area.
  2. Performing necessary fitting services.
  3. Training the patient how to put on and take off the treatment item.
  4. Instructing the patient on how to care for the treatment item.
  5. Making adjustments to the treatment item, if needed.

How Can I Bill?

Starting January 1, you should use the new and existing codes in the January 2024 Alpha Numeric HCPCS File for billing purposes. The updated file will be published soon. For more information on billing, refer to the MLN Matters: Lymphedema Compression Treatment Items: Implementation (PDF) document.

Where Can I Get More Information?

For further information on Medicare coverage for lymphedema compression treatment items, you can visit the website of TriStar Physical Therapy at https://www.tristarpt.com. They provide comprehensive resources and guidance for healthcare providers in this field.