Lymphedema Compression Treatment

Coverage

Coverage of lymphedema compression treatment items is available under the new benefit for use in treating beneficiaries with any diagnosis of lymphedema. Claims billed with a diagnosis not listed below will be denied as noncovered. An Advance Beneficiary Notice of Noncoverage (ABN) is not required in these situations; however, one may be issued to notify the beneficiary of financial responsibility.

  • Lymphedema, not elsewhere classified (I89.0)
  • Hereditary Lymphedema (Q82.0)
  • Postmastectomy Lymphedema Syndrome (I97.2)
  • Other postprocedural complications and disorders of the circulatory system, not elsewhere classified (I97.89)

Documentation

Benefit Category

Lymphedema compression treatments are a DMEPOS benefit category established for items furnished on or after January 1, 2024. Items include:

  • Standard daytime gradient compression garments
  • Custom daytime gradient compression garments
  • Nighttime gradient compression garments
  • Gradient compression wraps
  • Accessories (e.g., zippers, linings, padding or fillers, etc.) necessary for the effective use of gradient compression garment or wrap; and
  • Compression bandaging systems/supplies

Quantities

  • Payment for three gradient compression garments or wraps with adjustable straps per each affected extremity or part of the body can be made once every six months.
  • Payment for two nighttime garments per each affected extremity or part of the body once every two years.

Suppliers can bill for lymphedema compression treatment items for more than one body part or area per beneficiary. Also, both a daytime (gives a higher level of compression) and nighttime (offer milder compression and less snug against skin) garment for the same body part or area can be billed per beneficiary.

What Are My Responsibilities?

When you furnish a lymphedema compression treatment item, you're responsible for all aspects of providing the item, unless you work out an arrangement with an external fitter to perform the services. This includes:

  • Taking measurements of the patient's affected body area
  • Performing necessary fitting services
  • Training the patient how to take the treatment item on and off
  • Showing the patient how to take care of the treatment item
  • Adjusting the treatment item, if needed

You must be an enrolled DMEPOS Supplier to get Medicare payment for furnishing these treatment items. Please follow the CMS Medicare Enrollment Guide to enroll.

Payment for all necessary services associated with providing gradient compression garments and wraps, including fitting and measurements, is included in the national payment amounts made to the supplier of the item.

Modifiers

The right (RT) and left (LT) modifiers must be used with gradient compression garments, related supplies and accessories when laterality is indicated. Please utilize the Modifier Lookup Tool for questions on which modifiers are applicable to each HCPCS code.

When the same code for bilateral items (left and right) is billed on the same date of service, bill each item on two separate claim lines using the RT and LT modifiers and one unit of service (UOS) on each claim line. Do not use the RTLT modifier on the same claim line and bill with two UOS. Claims billed without modifiers RT and/or LT, or with RTLT on the same claim line and two UOS, will be rejected as incorrect coding.

Accessories

Accessories (e.g., zippers, linings, padding or fillers, etc.) necessary for the effective use of a lymphedema compression treatment item also fall under this benefit. For example, a liner that is used with a garment could be covered under this benefit if it is determined that it is needed to prevent skin breakdown associated with wearing the garment.

Replacement When Lost, Stolen, or Irreparably Damaged

Daytime: If one daytime garment or wrap is lost, stolen, or irreparably damaged, the DME MACs shall allow payment for three replacements. The frequency limitation clock of six months restarts based on the date of service for the replacement claim.

Nighttime: If a nighttime garment is lost, stolen, or irreparably damaged, the DME MACs shall allow two replacements. If only one nighttime garment or wrap is lost, stolen, or irreparably damaged, the frequency limitation clock of two years (24 months) restarts based on the date of service for the replacement claim.

Note: The RA modifier is required when replacing an item due to loss, irreparable damage, or when item has been stolen, a narrative explaining the reason for replacement is also required, if prior to end of RUL of the item.

Canceled Orders for Customized Items

When an order for a customized item is canceled, the beneficiary passes away before the scheduled delivery or the beneficiary's condition changed and the item is no longer reasonable and necessary or appropriate, suppliers are eligible for reimbursement for the labor and parts invested in the customization process.

Healthcare Common Procedure Coding System (HCPCS) for Lymphedema Benefit

Items being provided and billed must meet the description of HCPCS codes listed below:

HCPCS Code Long Description
A6520 Gradient compression garment, glove, padded, for nighttime use, each
A6521 Gradient compression garment, glove, padded, for nighttime use, custom, each
A6522 Gradient compression garment, arm, padded, for nighttime use, each
A6523 Gradient compression garment, arm, padded, for nighttime use, custom, each
A6524 Gradient compression garment, lower leg and foot, padded, for nighttime use, each
A6525 Gradient compression garment, lower leg and foot, padded, for nighttime use, custom, each
A6526 Gradient compression garment, full leg and foot, padded, for nighttime use, each
A6527 Gradient compression garment, full leg and foot, padded, for nighttime use, custom, each
A6528 Gradient compression garment, bra, for nighttime use, each
A6529 Gradient compression garment, bra, for nighttime use, custom, each
A6530 Gradient compression stocking, below knee, 18-30 mmhg, each
A6533 Gradient compression stocking, thigh length, 18-30 mmhg, each
A6534 Gradient compression stocking, thigh length, 30-40 mmhg, each
A6535 Gradient compression stocking, thigh length, 40 mmhg or greater, each
A6536 Gradient compression stocking, full length/chap style, 18-30 mmhg, each
A6537 Gradient compression stocking, full length/chap style, 30-40 mmhg, each
A6538 Gradient compression stocking, full length/chap style, 40 mmhg or greater, each
A6539 Gradient compression stocking, waist length, 18-30 mmhg, each
A6540 Gradient compression stocking, waist length, 30-40 mmhg, each
A6541 Gradient compression stocking, waist length, 40 mmhg or greater, each
A6549 Gradient compression garment, not otherwise specified
A6552 Gradient compression stocking, below knee, 30-40 mmhg, each
A6553 Gradient compression stocking, below knee, 30-40 mmhg, custom, each
A6554 Gradient compression stocking, below knee, 40 mmhg or greater, each
A6555 Gradient compression stocking, below knee, 40 mmhg or greater, custom, each
A6556 Gradient compression stocking, thigh length, 18-30 mmhg, custom, each
A6557 Gradient compression stocking, thigh length, 30-40 mmhg, custom, each
A6558 Gradient compression stocking, thigh length, 40 mmhg or greater, custom, each
A6559 Gradient compression stocking, full length/chap style, 18-30 mmhg, custom, each
A6560 Gradient compression stocking, full length/chap style, 30-40 mmhg, custom, each
A6561 Gradient compression stocking, full length/chap style, 40 mmhg or greater, custom, each
A6562 Gradient compression stocking, waist length, 18-30 mmhg, custom, each
A6563 Gradient compression stocking, waist length, 30-40 mmhg, custom, each
A6564 Gradient compression stocking, waist length, 40 mmhg or greater, custom, each
A6565 Gradient compression gauntlet, custom, each
A6566 Gradient compression garment, neck/head, each
A6567 Gradient compression garment, neck/head, custom, each
A6568 Gradient compression garment, torso and shoulder, each
A6569 Gradient compression garment, torso/shoulder, custom, each
A6570 Gradient compression garment, genital region, each
A6571 Gradient compression garment, genital region, custom, each
A6572 Gradient compression garment, toe caps, each
A6573 Gradient compression garment, toe caps, custom, each
A6574 Gradient compression arm sleeve and glove combination, custom, each
A6575 Gradient compression arm sleeve and glove combination, each
A6576 Gradient compression arm sleeve, custom, medium weight, each
A6577 Gradient compression arm sleeve, custom, heavy weight, each
A6578 Gradient compression arm sleeve, each
A6579 Gradient compression glove, custom, medium weight, each
A6580 Gradient compression glove, custom, heavy weight, each
A6581 Gradient compression glove, each
A6582 Gradient compression gauntlet, each
A6583 Gradient compression wrap with adjustable straps, below knee, 30-50 mmhg, each
A6584 Gradient compression wrap with adjustable straps, not otherwise specified
A6585 Gradient pressure wrap with adjustable straps, above knee, each
A6586 Gradient pressure wrap with adjustable straps, full leg, each
A6587 Gradient pressure wrap with adjustable straps, foot, each
A6588 Gradient pressure wrap with adjustable straps, arm, each
A6589 Gradient pressure wrap with adjustable straps, bra, each
A6593 Accessory for gradient compression garment or wrap with adjustable straps, not-otherwise specified
A6594 Gradient compression bandaging supply, bandage liner, lower extremity, any size or length, each
A6595 Gradient compression bandaging supply, bandage liner, upper extremity, any size or length, each
A6596 Gradient compression bandaging supply, conforming gauze, per linear yard, any width, each
A6597 Gradient compression bandage roll, elastic long stretch, per linear yard, any width, each
A6598 Gradient compression bandage roll, elastic medium stretch, per linear yard, any width, each
A6599 Gradient compression bandage roll, inelastic short stretch, per linear yard, any width, each
A6600 Gradient compression bandaging supply, high density foam sheet, per 250 square centimeters, each
A6601 Gradient compression bandaging supply, high density foam pad, any size or shape, each
A6602 Gradient compression bandaging supply, high density foam roll for bandage, per linear yard, any width, each
A6603 Gradient compression bandaging supply, low density channel foam sheet, per 250 square centimeters, each
A6604 Gradient compression bandaging supply, low density flat foam sheet, per 250 square centimeters, each
A6605 Gradient compression bandaging supply, padded foam, per linear yard, any width, each
A6606 Gradient compression bandaging supply, padded textile, per linear yard, any width, each
A6607 Gradient compression bandaging supply, tubular protective absorption layer, per linear yard, any width, each
A6608 Gradient compression bandaging supply, tubular protective absorption padded layer, per linear yard, any width, each
A6609 Gradient compression bandaging supply, not otherwise specified
A6610 Gradient compression stocking, below knee, 18-30 mmhg, custom, each

Resources

Last Updated Mar 12 , 2024

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