CMS Proposes Lymphedema Coverage Guidelines and Payments
Due to passage of the Consolidated Appropriations Act, 2023, the Centers for Medicare and Medicaid Services (CMS) will begin to reimburse for lymphedema standard and custom fitted gradient compression garments and other items as determined by the Secretary of Health and Human Services (HHS) beginning January 1, 2024.
On June 30, 2023, CMS released the calendar year (CY) 2024 Home Health Prospective Payment System proposed rule. In this proposed rule, CMS proposes the following regarding lymphedema compression treatment items:
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CRA states would not need to become enrolled and accredited Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS), correct?
Rehab Agencies would have to become enrolled if this proposed rule is finalized since lymphedema garments are not considered orthotics.
Rick at one time you said that Medicare Certified Rehabilitation Agencies could bill supply codes WITHOUT a DME. However, in this article, you state that you need a DME to bill for the lymphedema supply codes.
Do rehab agencies need a DME to bill lymphedema supply codes?
I said rehab agencies could bill for the L codes (orthotics) without requiring a DME supplier number.
Thank you, Rick. Since this guidance is included in the Home Health PPS proposed rule, am I correct in understanding it will not apply to outpatient therapists?
It will apply to OP therapists.
Good morning Rick. If the hospital network I work for has a DME license, would our PTs/OTs need to separately become enrolled and accredited as a DMEPOS supplier? Thank you!
My advice is to wait for the final rule to be released to see what CMS finalizes.
Re: Question #5 (Therapist taking measurements and fitting the garment but garments supplied by other vendor).
If my understanding is correct, the measurements are taken at the time of the initial evaluation could still be reimbursed as it falls under the evaluation code in which several things are being evaluated. However, the training, educating, and adjusting are now reimbursable when the patient returns with the garments is technically not reimbursable as the garment was supplied by another vendor.
Would you still be able to bill 29581 or 29584 on the return visit if you are applying the garments on the patient? It’s an untimed code so education/training could be a part of the application. If it’s 97140 then you could bill the time applying the garments but not educating/training the patient?
Go to https://gawendaseminars.com/faq/lymphedema-garments/ and read the answer to the 9th question.