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CMS details lymphedema coverage, supply refills, brace definitions

CMS details lymphedema coverage, supply refills, brace definitions

WASHINGTON – CMS has released a 2024 Home Health Prospective Payment System Rate Update final rule that includes updates to its new coverage policy for lymphedema compression garments and other DME-related items. 

Per the final rule, Medicare will pay for three daytime garments every six months and two nighttime garments every two years for each affected extremity or part of the body, an increase in daytime garments over the amount previously proposed. 

This rule also establishes the initial HCPCS codes and the payment methodology for these items and outlines how future coding, benefit category, and payment determinations for these items will be made. 

DMEPOS refills 

In response to concerns related to auto-shipments and delivery of DMEPOS supplies that may no longer be needed or not needed at the same level of frequency/volume, CMS will institute policies requiring suppliers to contact the beneficiary prior to dispensing DMEPOS refills. The agency will require documentation indicating that the beneficiary confirmed the need for the refill within the 30-day period prior to the end of the current supply. Additionally, CMS will codify its requirement that delivery of DMEPOS items (that is, date of service) be no sooner than 10 calendar days before the expected end of the current supply. 

Brace definition 

The rule also codifies the longstanding Medicare definition of brace to provide clarification on the scope of the Part B benefit for leg, arm, back and neck braces and, as a result, CMS will classify certain exoskeleton-type devices as braces for payment purposes. 

Read a fact sheet on the final rule.


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