How to Bill for CPT Codes 29581-29584

May 4, 2015
Rick Gawenda

Last week, I published an article on when to use CPT codes 29581-29584. This week, I will discuss the proper billing of these CPT codes with additional guidance how to bill if performing the procedure bilaterally. Before beginning, lets review the CPT description of CPT codes 29581-29584 and what they are used for.

29581 – Application of multi- layer compression system; leg (below knee), including ankle and foot

29582 – Application of multi-layer compression system; thigh and leg, including ankle and foot, when performed

29583 – Application of multi-layer compression system; upper arm and forearm

29584 – Application of multi-layer compression system; upper arm, forearm, hand, and fingers

These CPT codes are to be used when the therapist or assistant

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  1. On November 11, 2014 The AMA CPT Editorial Board announced in their Errata and Technical Corrections – CPT® 2015 that the exclusionary parenthetical note following CPT® 97140 referencing the multilayer compression system codes CPT® 29581-29584 was being deleted, thereby allowing the billing of the strapping and MLD codes on the same day on the same patient. This paves the way for the use of the strapping codes for bandaging after manual lymph drainage.

    HOWEVER: NCCI Edits for 2015 have not been changed to reflect this change. Also, further CPT code descriptions must be made expanding the use of previous “strapping codes” to other than musculoskeletal and venous conditions, and CMS must now follow up and remove restrictive wording in their coding and billing instructions.

  2. Hi Rick,
    I am assuming that you can charge one of the 29581-29584 codes for wrapping on the same day that you charge 97140(manual) for manual lymph drainage if you are performing both on the same day??

    1. With Medicare Part B, yes. With other insurance carriers, you would need to check their payment policies but I would hope the answer would be yes.

        1. Please read the 2022 and 2023 NCCI Edit Policy Manual where CMS states 29581 and/or 29584 can be billed the same day as 97140.

  3. Are the supplies used during the bandaging included in this charge or are they billed separately? Such as bandages, padding etc.

  4. I am having trouble getting reimbursed by MC. The deny stating it needs a modifier but I cannot determine which one. We have used 59.

    1. They are used with patient’s with lymphedema and also venous insufficiency. You would have to check with the insurance carrier to see if they do pay for these CPT codes. Not all insurance carriers pay for all of our CPT codes.

    1. You would need to check with each insurance carrier to see if certain ICD-10 codes must be on the claim to support the CPT codes you are billing.

    1. The key is does it meet the definition of a multi-layer compression system. That is what you need to determine.

  5. What if you have an amputee and the patients thigh needs to be bandaged? I am not sure how to code this because the only thigh option includes the leg, ankle and foot.

    1. In my opinion, none of the codes would be applicable for this patient. If an amputee, it might fall under CPT code 97761 (prosthetic management and training).

  6. CPT’s 29583 and 29582 are being deleted for 2018. Are there recommendations for replacement codes for lymphedema compression wrapping?

  7. The wound clinic physical therapists frequently use codes 29580, 29581, and 29445. As they are multidisciplinary codes not in the 97xxx series, there is confusion as to whether these codes count toward the annual Medicare cap for PT. Do you know if these count toward the Medicare cap?

    1. These codes do not count towards the annual therapy threshold since they are not considered “always” or “sometimes” therapy codes.

  8. At the establishment where I work it is being asked the CPT 29581 be coded a a procedure, my question is should the coder code it as a CPT or is it included in the visit charge?

    1. I assume you mean 29581 and 29584. If yes, CMS does pay for those 2 CPT codes in all outpatient therapy settings. Check with your Medicare Administrative Contractor to see if they have any special requirements for the payment of those 2 CPT codes.

  9. Are 29581 and 29584 per treatment codes? What exactly does that mean? Can we bill the codes at each visit or is it once per dx?

    1. They are untimed CPT codes. They can be billed each treatment, if applicable and appropriate.

  10. If an OT charges 29581 or 29584 on evaluation, does the COTA also charge that code on subsequent visits if reapplying the bandage? Or does the COTA charge a different code (ie 97530 or 97535) for reapplying the bandage using the same supplies?

    1. 29581 and 29584 can be billed over multiple visits if it requires the skills of a therapist or an assistant under the supervision of a therapist to perform.

  11. If billing 29581 for BLE, can you bill 97140-59 for BLE manual lymphatic drainage? Or do you have to do manual lymphatic drainage to regions other than BLE? Thanks.

    1. 97140 is for the MLD techniques and 29581 and 29584 is for the multi-layer compression system.

  12. Our system told us to only bill 29581-29584 on the first day of bandage application and to use 97140 for future treatments (including manual lymph draining and re-wrapping). Are 29581-29584 only 1x codes?

  13. If these codes are used and reimbursed for lymphedema then should it be utilized as a code only for initial application and education on self wrapping/maintenance (i.e. 3-4 visits) before switching to CPT 97140? Or should it continued to be utilized throughout the course of treatment when you are applying the wraps as a skilled intervention?