July Quarterly Update for 2006 Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Fee Schedule has just been issued.
July Quarterly Update for 2006 Durable Medical Equipment, Prosthetics,
Orthotics, and Supplies (DMEPOS) Fee Schedule has just been issued.
"HCPCS codes A6531 and A6532 were added to the HCPCS January 1, 2006, to replace L8110 and L8120; therefore, all billing and payment
requirements for HCPCS codes L8110 and L8120 crosswalk directly to A6531 and A6532, including the requirement to bill modifier AW when items are furnished for use as surgical dressings (see transmittal AB-03-100)."
AB-03-100 states the policy:
"Effective for items furnished on or after October 1, 2003, gradient
compression stockings falling under the following codes may be covered
under the surgical dressing benefit when the beneficiary has an open
venous stasis ulcer that has been treated by a physician or other
healthcare professional requiring medically necessary debridement, and
when the gradient stocking can be proven to deliver compression greater
than 30 mm Hg. and less than 50 mm Hg:
L8110 GRADIENT COMPRESSION STOCKING, BELOW KNEE, 30-40 MMHG, EACH AW - ITEM FURNISHED IN CONJNCTION WITH A SURGICAL DRESSING should follow this code;
L8120 GRADIENT COMPRESSION STOCKING, BELOW KNEE, 40-50MMHG, EACH AW -
ITEM FURNISHED IN CONJNCTION WITH A SURGICAL DRESSING should follow this code."
All other compression garments are omitted from the 2006 DMEPOS pricing
In other words, the only compression garment covered by Medicare today
is a below knee compression stocking used as a secondary dressing
covering a primary dressing over an open venous stasis wound. With
compression garments gone, how do we treat lymphedema?
Has this gotten any lymphedema patients angry enough to write to your
Congressmen? I'll help you, but only YOU can contact your
representatives in Congress.
I have written a proposed bill you can send them to remedy this and other Medicare failings to cover
lymphedema treatment and to reduce Medicare costs at the same time..
Robert Weiss, M.S.
Lymphedema Treatment Advocate
National Lymphedema Network