Lymphedema Treatment Act Resources

• Adjustable Wraps
• Nighttime
• Efficacy Aids
• Bandages
• Knit (RTW & Custom) - toe, knee, thigh, waist, arm, glove. genital, neck/head

_{A HCPS Code (healthcare Common Procedure Coding System Codes) is never a guarantee of coverage or payment for any claim submitted for payment to any private and public insurance carrier.}

DIAGNOSIS CODES NEEDED FOR COVERAGE:

• 189.0 – Lymphedema, not elsewhere classified
• Q82.0 – Hereditary Lymphedema
• 197.2 – Postmastectomy Lymphedema Syndrome
• 197.89 – Other postprocedural complications and disorders of the circulatory system, not elsewhere classified

^{Please note: A HCPCS Code (Healthcare Common Procedure Coding System Codes) is never a guarantee of coverage or payment for any claim submitted for payment to any private and public insurance carrier.}

^{If you need further information reach out to your JOBST® sales representative or visit https://www.cms.gov/medicare/payment/fee-schedules/dmepos-fee-schedule/lymphedema-compression-treatment-items.}

^{The Centers for Medicare & Medicaid Services (CMS) uses the Palmetto GBA LLC.,  as the Medicare Administrative Contractor (MAC) for Pricing, Data Analysis, and Coding (PDAC). The PDAC Contractor maintains the Product Classification List, located at https://www4.palmettogba. com/pdac.dmecs/. The Product Classification List is a searchable database containing products that have received HCPCS Coding Verification from the PDAC and their corresponding HCPCS Codes. BSN Medical Inc., however, makes no representations as to the accuracy of the information contained within the PDAC Database, nor any representations as to whether its products are reimbursable under any government sponsored healthcare program and/or private-insurance program. It is the provider’s sole responsibility, in consultation with the insurer, if necessary, to determine medical necessity, ensure coverage criteria is met, and submit appropriate HCPCS Codes, modifiers, and charges for services rendered. RV: 12/25}