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
