Medicare provides coverage for three EXTREMIT-EASE compression garments per body area once every six months when the garment is being used to treat lymphedema.

There are potential exceptions to this six month timeline.  Medicare allows an entire new set of 3 replacement garments if one or more lymphedema compression garment is lost, stolen, suffers irreparable damage or if there is a change in the patient’s condition resulting in the need for a garment of another size.  If this replacement occurs, it restarts the 6 month clock on another set of replacements.

The RA Modifier should be used for the replacement claim if the claim is being submitted because the original(s) were lost, stolen, or irreparably damaged.

Take Home Message:  If a patient’s lymphedema compression garment is:

  • Lost
  • Stolen
  • Irreparably damaged

OR

  • There is a change in the patient’s condition that warrants a change in garment size (like the size of the leg is way down)

a replacement claim may be submitted for 3 new garments and the RA Modifier should be used on this claim form.

Reference: https://cgsmedicare.com/jb/pubs/news/2023/12/cope147943.html

Dr. Jeffrey D. Lehrman, DPM, FASPS, MAPWCA, CPC
Dr. Jeffrey D. Lehrman, DPM, FASPS, MAPWCA, CPC, CPMA
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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.