The USMCA works to ensure clinically appropriate, high quality, medical compression garments are available to Medicare recipients with a lymphedema diagnosis in compliance with the Lymphedema Treatment Act (LTA), which passed December 2022. The resources below provide the latest information regarding implementation of this coverage.
Stay informed of the latest updates around insurance coverage for lymphedema treatment items below and review our FAQs.
After reviewing the CMS publication that indicated 71 lymphedema codes would be bundled into home health payments, USMCA rallied stakeholders and educated CMS on the negative impact to patients. CMS rescinded that decision and issued a correction, Sept. 25. Lymphedema garments will continue to be reimbursable SEPARATELY for patients, including those receiving home health care.
When USMCA received notification that O&P licensure requirements had been added to approximately 12 states, we collaborated with BOC and Noel Neil, to raise the issue to CMS and several contractors. USMCA submitted a formal statement to the NPE, which manages the DMEPOS State Licensure Database, opposing O&P requirements—citing the challenges and voicing support for developing credentials in the future. NPE removed all O&P requirements, Oct. 7, and updated the S04 licensure database.
Reimbursement & Market Access Consultant Carmen Anderson and Noel Neil, ACU-Serve Chief Compliance Officer, address FAQs around insurance billing, documentation, reimbursement and more.
Board of Certification/Accreditation (BOC) accredits businesses that provide DME, allowing them to bill third-party payors, including CMS. BOC offers several helpful resources for DMEPOS accreditation. MEPOS Supplier Business
USMCA compiled these resources to help navigate the implementation of the Lymphedema Treatment Act.
CGS Provider Outreach and Education developed this Fact Sheet to help you quickly understand the new Lymphedema Compressions Treatment Items benefit. Scroll to the bottom of that page to access additional resources.
The USMCA summarized the public information (published Jan. 22, 2024) regarding the LTA final rule with links to helpful resources. Access the article.
USMCA Consultant Carmen Anderson authored the article, "Medicare Coverage Expanded to Include Lymphedema Compression Supplies in 2024" for a recent AVF newsletter.
The Lymphedema Advocacy Group shared two webinars that provide a wealth of information for clinicians and suppliers. Linda Roherty, PT, CLT-LANA, and Guenter Klose hosted "LTA & Medicare Documentation Requirements Unpacked." SunMed Medical, with the National Lymphedema Network, led the "Putting the Pieces Together for Clinicians" webinar.
Centers for Medicare & Medicaid Services (CMS) outlines what's covered, how often, who is eligible and more. Visit the CMS site to learn more.
This publication provides billing and coding guidance pertinent to lymphedema compression treatment items, based on the CMS Final Rule CMS-1780-F. Read the article. Use this helpful online tool to look up the fee schedule based on HCPCS code.
Information USMCA shares on this website is intended solely for general educational purposes—not as professional advice. Always seek advice of a qualified healthcare professional if you need a medical diagnosis or treatment, as it relates to topics discussed. Do not disregard advice you have received, nor delay getting such advice, because of something you learn on this website or in our videos.
Questions? Email contact@usmedicalcompressionalliance.org.
Copyright © 2024 US Medical Compression Alliance - All Rights Reserved.
Powered by GoDaddy
We use cookies to analyze website traffic and optimize your website experience. By accepting our use of cookies, your data will be aggregated with all other user data.