On November 1, CMS released the CY 2024 Final Home Health Prospective Payment System Final Rule. This Rule contains significant changes that expands coverage for lymphedema treatment, including EXTREMIT-EASE.
Lymphedema Coverage
Starting January 1, 2024, ready-to-wear, non-elastic, gradient compression wraps with adjustable straps (like EXTREMIT-EASE!) will be covered for the treatment of lymphedema in the absence of an open ulcer. When being used to treat lymphedema, three daytime garments or wraps with adjustable straps for each affected limb or area of the body will be allowed, with replacements every 6 months when medically necessary. Payments for compression bandaging systems under this benefit category will include Phase 1 (acute or decongestive therapy) and Phase 2 (maintenance therapy) lymphedema treatments.
New Coding
With this change, there will be a new set of HCPCS codes to represent compression garments when they are used for lymphedema. This will result in EXTREMIT-EASE having two different codes, and selection will depend on if it is being used for chronic venous insufficiency (A6545) or if it is being used for lymphedema (A6583).
The code descriptors for A6531, A6532, and A6545 will be modified to clarify their use under the surgical dressing benefit. The modification will include adding “used as surgical dressing, each” to the end of the current code descriptors.
Lymphedema Versus CVI
This change reinforces the need to differentiate between chronic venous insufficiency and lymphedema. A basic explanation of the difference is, lymphedema is an abnormal accumulation of lymphatic fluid and chronic venous insufficiency is an abnormal accumulation of blood. They have different causes and, while there is some overlap in presentation, much of the clinical presentation differs.
The coverage guidelines when using EXTREMIT-EASE for venous leg ulcers / chronic venous insufficiency are not changing.
Dr. Jeffrey D. Lehrman, DPM, FASPS, MAPWCA, CPC, CPMA
Dr. Lehrman is a podiatrist practicing in Fort Collins, CO and operates Lehrman Consulting, LLC which provides consultation services regarding coding, compliance and documentation. Dr. Lehrman is a Certified Professional Coder and Certified Professional Medical Auditor. He serves as a staff liaison at the AMA CPT® Editorial Panel meetings where CPT codes are created, edited, and deleted. He is a Diplomate of the American Board of Foot and Ankle Surgery, Fellow of the American Society of Podiatric Surgeons, and is recognized as a “Master” by the American Professional Wound Care Association. Dr Lehrman is a Fellow of the American Academy of Podiatric Practice Management, Past Director of the American Professional Wound Care Association Board of Directors, and is a Past Chairman of the Board of the American Society of Podiatric Surgeons. Dr. Lehrman is also on the editorial advisory board of the journal WOUNDS.
