Noridian and CGS Provider Outreach and Education have released the most frequently asked questions (FAQs) on lymphedema compression treatment items under the Lymphedema Treatment Act. An important thing to note is that if the patient has MLD services on a given date, there cannot be a Durable Medical Equipment (DME) order on that date for bandages. CMS considers this “duplicate services.”
It is also important to note that if the patient has a venous leg ulcer, DME supplies for that condition should still be billed under the “Surgical Dressing benefit” A6545 and not under the lymphedema treatment items. It is not possible to bill under both!
QUESTION: If a physical therapist is applying the lymphedema wraps and billing for the application of the wraps, can we as a DME company bill separately for the wraps being applied by the therapist?
ANSWER: No, the DME company may not bill separately for supplies used by the lymphedema physical therapist. Per CMS-1780-F (page 361/531):
“With regards to payment, we note that currently a therapist who applies compression bandaging supplies during Phase 1 of treatment can bill for the service of applying the bandages using CPT codes 29581 and 29584. It is important to note, however, that if the CPT codes are billed and paid for a particular date of service, then billing for the bandaging supplies used during that date of service using the HCPCS A codes is not allowed and would be denied as it would result in duplicate payment of the supplies since the Medicare payment amounts for codes 29581 and 29584 include payment for the compression bandaging supplies.”
Suppliers of lymphedema garments and accessories are responsible for all aspects of furnishing the item, including fitting and measuring services. A supplier receiving payment for supplying a lymphedema compression treatment item to a beneficiary is responsible for ensuring that any necessary fitting, training (how to apply/remove and maintain). The supplier receiving payment for the garment may work out an arrangement with the therapist for the fitting part that is an integral part of supplying the item.
QUESTION: If a patient has lymphedema and has a leg ulcer and we are providing gradient compression wraps, which code do we use: A6583 or A6545, or would we bill both HCPCS codes?
ANSWER: The supplier must choose which benefit to bill the item(s) under, either Surgical Dressings or Lymphedema Treatment Items. If providing for the surgical dressings benefit, bill HCPCS code A6545; if providing for the lymphedema garments benefit, bill HCPCS code A6583. Under no circumstances should the supplier bill both HCPCS codes to represent one product.
Related posts:
