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Home Health Final Rule - Lymphedema Compression Garments

2 Nov 2023 9:34 AM | Zachary Edgar (Administrator)

Lymphedema Compression Treatment Items

Section 4133 of the CAA, 2023 establishes a Medicare Part B benefit for standard and custom-fitted gradient compression garments and other compression treatment items for the treatment of lymphedema that are prescribed by an authorized practitioner.

Compression garments for treatment of lymphedema have not been previously covered by Medicare because, prior to the enactment of the CAA, 2023, there was no statutory benefit category for such items. This rule addresses the scope of the new benefit by defining what constitutes a standard- or custom-fitted gradient compression garment and identifying other compression items used for the treatment of lymphedema that fall under the new benefit category, beginning January 1, 2024.

The rule sets forth Medicare payment for gradient compression garments for both daytime and nighttime use as well as ready-to-wear, non-elastic, gradient compression wraps with adjustable straps and compression bandaging systems applied in a clinical setting as part of phase one decongestive therapy as well as during phase two maintenance therapy. The rule establishes that Medicare will pay for an increase in daytime garments over the amount previously proposed.

Medicare will pay for three daytime garments every six months and two nighttime garments every two years for each affected extremity or part of the body. This rule establishes the initial Healthcare Common Procedure Coding System (HCPCS) codes and the payment methodology for these items and outlines how future coding, benefit category, and payment determinations for these items will be made.

The payment basis that we are finalizing for lymphedema compression treatment items approximates the payment methodology by the Department of Veterans Affairs, which is the average Medicaid State agency payment amounts plus 20 percent. In the event that Medicaid State agency payment rates are not available, payment rates will be based on the average of payment amounts established by TRICARE and internet retail prices.

If neither Medicaid nor TRICARE payment amounts are available, Medicare payment rates will be based on the average internet retail prices for a lymphedema compression treatment item.

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