Dedicated to Lymphedema Patients and the Therapists Who Treat Them
Who we are
My 2002 Legislative Plan
Fear of Lymphedema
NIH Trial Registry
Comments on TA
Efficacy of CDT
Hospital Discharge Study
Cost of Mandate
Surgical Dressing LCD
Jimmo v. Sebelius
PM&R LCD Retired
Face to Face
PCD LCD Updated
Letter to CMS
PCD LCD 2015
Denials & Coding
HCPCS Level II
Call to Action
Q&As for 2013
Extended Thru March 2014
LCD Comment Period
Draft LCD Text
Home Health Episode Caps
ACA & Lymphedema
CA Garment Coverage
ALJ Hearing Request
Justification for MLD
LMTs with MLD Certification
LMTs & Medicare
Justification for Garments
Lifetime Limit to CDT?
Effects of Radiotherapy
Effect of Code Changes
Pump Abdominal Appliance
Getting a Pump
Pump with Abdominal
4-week trial for PCD
Mortimer & Rockson (2014)
Dedicated to Lymphedema Patients and the Therapists Who Treat Them
INSURANCE & MEDICARE
2017 Annual Update to the Therapy Code List. For CY 2017, the Current Procedural Terminology (CPT) Editorial Panel created eight new codes (97161-97168) to replace the 4-code set (97001-97004) for Physical Therapy (PT) and Occupational Therapy (OT) evaluative procedures. The new CPT code descriptors for PT and OT evaluative procedures include specific components that are required for reporting as well as the corresponding typical face-to-face times for each service.
FORMAL REQUEST MADE BY LYMPHACTIVIST FOR MEDICARE COVERAGE OF LYMPHEDEMA COMPRESSION ITEMS. Based on twenty years of advocacy and over 100 ALJ appeals, I have submitted a formal request to CMS for Medicare coverage of lymphedema compression bandages, garments, devices and supplies as prosthetic device benefits. Personally this is a significant time, since October 2016 will mark 25 years since my wife Pearl was diagnosed and treated for breast cancer and started her lymphedema odyssey.
LYMPHACTIVIST'S COMMENTS TO PROTECT YOUR APPEAL RIGHTS. As the backlog of appeals pending Administrative Law Judge (ALJ) hearings approaches 1 million cases, the Department of Health and Human Services (DHHS) has proposed statutory changes to the appeal system. The major aims of these statutory changes are to reduce the current backlog, and to reduce the number of new appeals reaching the third level of appeal, i.e. the ALJ Hearing. Some of these changes reasonably streamline the appeal process, but others could chip away at current appeal rights of Medicare beneficiaries. LymphActivist has submitted a response to DHHS during the comment period th at just ended , pointing out potential dangers in some of the proposed changes.
Another nail in the lymphedema reimbursement coffin?
The proposed Physician Fee Schedule for 2017 CMS-1654-P contains the latest proposed changes to physical therapist reimbursement rules. It continues to determine reimbursement on the basis of "body structure and function", and could effectively rule out treatment of lymphedema before it becomes disabling. See CALL TO ACTION below.Comments are accepted until September 6, 2016. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/PFS-Federal-Regulation-Notices-Items/CMS-1654-P.html
CALL TO ACTION !!!! IMPACT OF UPCOMING MEDICARE REIMBURSEMENT CHANGES ON LYMPHEDEMA TREATMENT PRACTICE
A letter was written to the Chief Medical Officers of the four DME MACs urging them to change the upcoming revised pneumatic compression device (PCD) local coverage determination (LCD) to better reflect new knowledge of lymphedema and new technologies.
An updated version of the PCD LCD is scheduled to become effective nationwide on December 1, 2015. Major changes in qualification trials, face-to-face encounters and documentation requirements will make it more difficult for lymphedema patients to obtain lymphedema PCDs.
LymphActivist's analysis of the history of PCD LCD changes and comments on the profound impact on lymphedema patient's access to lymphedema pumps.
Comments are solicited for changes to Surgical Dressing Local Coverage Determination (DL33831) and Surgical Dressing Policy Article (A54563 DRAFT). These are the documents cited for denials of compression garments due to a misinterpretation of Medicare statutes.
Response to Senate Finance Committee request for suggestions for improved care for Medicare patients with chronic conditions.
Proposed Local Coverage Determination on Bioimpedance Spectroscopy Devices for Detection and Management of Lymphedema (DL36141) would deny Medicare coverage of L-Dex measurement in ten states. Comments solicited at upcoming open meetings.
Therapy Caps Exceptions Process Extended Through CY 2017-- The therapy caps exceptions process for PT, OT, and SLP services was extended through the remainder of CY 2015, and for all of CY 2016 and CY 2017, when the Medicare Access and CHIP Reauthorization Act was signed into law on April 16, 2015.
CMS announces that use of the -59 Distinct Procedural Services modifier will be allowed after January 1, 2015 along with the new -X[EPSU] modifiers in appropriate circumstances.
2015 CPT® no longer excludes simultaneous multilayer bandaging and MLD. May be billed for same encounter.
Medicare Changes 2014-2015 Relevant to Therapy Services. Presented at the Networking & Educational Seminar for Lymphedema Therapists, Rancho Mirage, CA May 1-3, 2015.
Time for APTA and AOTA to propose quality measures for treatment of lymphedema without functional deficiency or debridable wounds, but for prevention and treatment of the medical condition itself.
Lymphedema Treatment Option Passes in Louisiana — A Step Backward for Lymphedema Patients?
The Affordable Care Act and Lymphedema. California Adds Coverage of Compression Bandages and Garments!
Lymphedema Pump Ordering Policy Modified. Requires Physician or NPP Face-To-Face Meeting. Certificate of Medical Necessity Clarifications.
Medicare Will ReconsiderTherapy Maintenance Care Denials Because of Lack of Functional Improvement 2011-2014. Reconsideration Forms and Instructions Available.
Durable Medical Equipment(DME) Minimum Lifetime Reaffirmed as 3 Years. Grandfathering Clarified.
Medicare Therapy Caps and Exception Process Extended Until March 31, 2014. Annual Cap Raised to $1920 and Manual Review Threshold Remains at $3700.
Manual Updates Issued to Clarify Skilled Nursing Facility (SNF), Inpatient Rehabilitation Facility (IRF), Home Health (HH), and Outpatient (OPT) Coverage Pursuant to Jimmo vs. Sebelius
CMS Retires Physical Medicine LCD… Casualty of
(The Case of the Disappearing Improvement Standard)
Insurance Coverage of Lymphedema Compression Bandages and Garments Starts Jan 1, 2014 in California.
Caution: Home Health Episode Payment Caps
MedPAC Recommendations for Changes to Medicare Outpatient Therapy Services
Medicare urges seniors to join the fight against fraud New health care summaries help seniors identify improper payments
(Non)Coverage of Lymphedema Treatment
Therapy Functional Outcome Reporting at the Lymphedema Seminar
Items Requiring Coding Verification Reviews by the PDAC
REVIEW - Weiss (2016) Cost of a lymphedema treatment mandate - 10 years of experience in the Commonwealth of Virginia.
REVIEW - Hansdorfer-Korzon (2016): Low-pressure compression corsets for treatment of patients after mastectomy and lymphadenectomy.
Some new recommendations of the American Academy of Dermatology may relate to lymphedema prevention and treatment.
Cochrane Review (2015): Manual lymphatic drainage for lymphedema following breast cancer treatment.
REVIEW - Shaitelman (2015) Recent Progress in the Treatment and Prevention of Cancer-Related Lymphedema, a generally excellent review, suffers from major omissions and inaccuracies.
REVIEW - Mortimer & Rockson (2014): New Developments in Clinical Aspects of Lymphatic Disease.
REVIEW - Baker (2014): Lymphatic Function is Impaired Following Irradiation of a SingleLymph Node.
REVIEW - Johansson (2014): Measurement of Breast Lymphedema with a Tissue Dielectric Constant Meter.
REVIEW - Zimmermann (2012): Can Early Manual Lymph Drainage Prevent Breast Cancer-Related Lymphedema?
REVIEW - Dayes (2013): Is Elastic Compression Alone as Effective as Manual Lymph Drainage and Elastic Compression?
Proposed expansion of the ICD-10-CM diagnostic codes for primary, secondary and mastectomy-related lymphedema include body site, severity and co-conditions.
All you need to know about Sequential Compression Devices
Incidence and Prevalence of Lymphedema
Does Breast Cancer Patients' Fear of Developing Lymphedema Far Exceed Risk ???
Review of Evidence on Efficacy of Lymphedema Treatment Protocols
Efficacy of Lymphedema Protocols
Appropriate Use of Pneumatic Devices in Treatment of Lymphedema patients