Lymphedema and CPT Codes 29581 & 29584

March 8, 2021
 / 
Rick Gawenda
 / 

The American Medical Association created CPT code 29581 that became effective for dates of service on and after January 1, 2010 and CPT code 29584 that became effective for dates of service on and after January 1, 2012. Even though these codes have been active for 11 and 9 years respectively, there is still much confusion regarding the use and billing of these codes for patients who have lymphedema and are receiving outpatient physical and/or occupational therapy services.

In this article, I will answer the following questions:

  1. What is the description of each CPT code?
  2. Are these CPT codes time-based or untimed?
  3. Can these codes be billed by physical therapists, physical therapist assistants, occupational therapists and occupational therapy assistants?
  4. Does the Medicare program pay for CPT codes 29581 and 29584?
  5. Do commercial and private insurance carriers pay for CPT codes 29581 and 29584?
  6. Can CPT codes 29581 and 29584 be billed by physical therapists, physical therapist assistants, occupational therapists and occupational therapy assistants who apply a multi-layer compression wrap for a patient with a diagnosis of lymphedema?
  7. If I provide a multi-layer compression wrap to either both upper extremities or lower extremities, how would I do the billing?
  8. If an insurance carrier does not pay for CPT codes 29581 and 29584, can I add the minutes it takes me to perform the compression bandaging to the manual therapy CPT code, 97140?

Lets begin!

Question
What is the description of each CPT code?

Answer

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Question
Are these CPT codes time-based or untimed?

Answer

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Question
Can these codes be billed by physical therapists, physical therapist assistants, occupational therapists and occupational therapy assistants?

Answer

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Question
Does the Medicare program pay for CPT codes 29581 and 29584?

Answer

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Question
Do commercial and private insurance carriers pay for CPT codes 29581 and 29584?

Answer

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Question
Can CPT codes 29581 and 29584 be billed by physical therapists, physical therapist assistants, occupational therapists and occupational therapy assistants who apply a multi-layer compression wrap for a patient with a diagnosis of lymphedema?

Answer

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Question
If I provide a multi-layer compression wrap to either both upper extremities or lower extremities, how would I do the billing?

Answer

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Question
If an insurance carrier does not pay for CPT codes 29581 and 29584, can I add the minutes it takes me to perform the compression bandaging to the manual therapy CPT code, 97140?

Answer

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  1. We treat people with lymphedema 5 days / week for approximately 2 weeks. Can we bill 29581 every visit, plus 1-2 units of 97140 or 97124?

    1. You would need to know what the patient’s coverage is for therapy and then make sure documentation supports that level of intensity. Technically, you can bill whatever you want as long as it’s provided. The key is the insurance coverage and your documentation on whether you will be reimbursed or not.

  2. Hello Rick;
    Can these codes be billed with 97140 – manual therapy during the same visit?
    Thank you.

  3. Does this code cover only the application of the bandages? If you are billing bandages to the insurance, do you use different supply codes?

      1. We were told that the bandages are a part of the 29581 and 29584 codes, so we should only bill it once as we only give the bandages out once. However, if CMS now covers garments, bandages, zippers, fillers, etc when supplied by a DMEPOS, doesn’t that throw everything off? The practice expense didn’t change very much from 2023 to 2024.

        1. If you are billing 29581 and 29584, that would include the supplies to do the multi-layer compression bandaging.

          1. Thank you. If the skill of the therapist is required to do the multi-layer compression bandaging on follow-up visits, then is the code still applicable if new supplies aren’t provided?

          2. That is for you to determine if the skills of a therapist are required to perform the multi-layer compression bandaging.

  4. I was hoping for clarification. It describes the codes are to be used for a multi layer system. Is that a special device this is referring to or simply the application of the wrapping.

    1. There is no Medicare cap. It has been called a therapy threshold since January 1, 2018. To answer your question, no.

  5. Hi Rick
    I’m confused as to why the code only covers the lower leg. Quite often we have to wrap the entire leg. Is there a code for that as it certainly is a lengthier procedure.

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

  6. Rick,
    Regarding your above answer to the question about CPT codes 29581 or 29584 when applied bilaterally:
    “You would bill the applicable CPT code for 1 unit with the full charge for both applications and apply modifier 50 to that CPT code on the claim form. For Medicare and many commercial payors, proper application of modifier 50 increases reimbursement to 150 percent of the allowable fee…” Would the charge billed need to be at least the 50% above the allowable amount than in order to receive the 150%? Meaning, if my charge was just the allowable and I used modifier 50, my assumption is I am just going to receive that charge and not expect to see them add the additional 50% because I did not charge for it? Can you please clarify. Thank you.

    1. I would make sure your charge for the service is above the dollar amount that you are expecting the insurance carrier to reimburse.

      1. Yes I understand,
        but if the amount expected for unilateral care is say $92 and I charge $100, and then do bilateral care and am using the same CPT code but just adding a modifier 50, my reimbursement would only be $100 rather than $138 (50% above allowed unilaterally). Is that correct? That would suggest to me I would want to charge, in this case, something like $140 whether performing the procedure unilaterally or bilaterally. Is my thinking correct on that? Thank you.

        1. You would want to make sure your charge is at least, if not higher, than what you are expecting to be reimbursed.

  7. Hello, I sent this via the contact me link as well but wasn’t sure which method was more appropriate.

    The CCI edit page and your comments above seem to indicate that 29581 can be billed with 97140 with a 59 modifier. However, our coding team is indicating that is not true if both are being performed in the same anatomic region. They are referencing the chapter 4 of the NCCI policy manual on page 16 it has the statement pasted below. Can you comment on if you believe they are interpreting this accurately in stating that 97140 and 29581 cannot be billed for the same anatomic region in the same day? If you do not believe it is accurate can you provide additional support for why?

    17. Application of a multi-layer compression system (CPT
    codes 29581-29584) includes manual therapy in the anatomic
    region of the multi-layer compression system. CPT code 97140
    (Manual therapy techniques…) shall not be reported for any
    type of manual therapy at the same patient encounter in the
    anatomic region where a multi-layer compression system is
    applied.

  8. Is there a limit to how many times you can bill these treatment codes? 3 or fewer treatments?

    1. That would be insurance carrier specific if they limit the billing and reimbursement of any CPT codes.

  9. I just received noticed from our hospital’s coding team with link to http://www.cms.gov/medicare-coverage-database that suggests the CMS National Coverage Policy is that “there is no Medicare coverage for lymphedema compression bandage application as this is considered to be an unskilled service. The non-coverage extends to the application of high compression, multi-layered, sustained bandage systems. Minutes spent applying compression without patient/caregiver education should not be billed as skilled therapy services” It does suggest that CPT 97535 can be used the first few times for caregiver education and that the 29581 and 29584 are only to be used in treatment of wounds.

    This seems to be in conflict with guidance in this article. Has the policy changed since the article was posted?

    Thanks in advance!

    1. We got the NCCI edits changed effective January 1, 2022 and now we have to work on reversing this policy.

  10. Can you provide an update to these codes? CMS website says these codes were retired as of 7/19/23 but may reimburse non-lymphedema wrapping if they Medicare requirements.

      1. Thank you! So we’ve previously been taking a loss for giving these items out for free. If we have a DME license, can we bill for the garments (and appropriate measurements, training, etc) on the initial encounter and then the application code in follow-up visits? Or does the application code (29581) still apply during the initial application of the garments?

        Is it known if the application code reimburses more than what CMS will pay for the garments (including measuring, application, etc)?

        1. If you are billing the applicable HCPCS for for the garment, this includes the fitting so in my opinion, 29581 and 29584 would not be appropriate.