When Do I Use CPT Codes 29581-29584

April 27, 2015
Rick Gawenda

I often receive questions on when do I use CPT codes  29581 – 29584 and does the Medicare program and other insurance carriers pay for them? Before I answer when to use them and if they are payable, lets provide the description of each CPT.

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

Now to the big question. For what situations do providers use these CPT codes and are they payable by the Medicare program and other insurance carriers? 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. Our lymphedema clinic has historically included compression wrapping as a part of the manual therapy billing, and to be able to bill for these two separate treatments would be an obvious benefit. However, as we research billing these codes, we have found other reliable resources that seem to negate their use for lymphedema treatment. Noridian (MAC for Jurisdiction E) specifically states that “Compression application CPT codes 29581-29584 may be appropriately billed for the treatment of wounds
    when indicated; however, these codes should not be billed for unskilled lymphedema compression bandage
    application.” Lymphactivist.com notes that the addition of the compression system codes was included as part of venous ulcer treatment, which we have been able to verify by searching the Local Coverage Articles through our Jurisdiction L MAC, Novitas. What we have been unable to find is definite proof that these codes are considered medically necessary for a lymphedema diagnosis. Can you provide further explanation or evidence?

    1. You would want to purchase CPT Changes 2012: An Insider’s View. Lymphactivist.com is incorrect as is your MAC.