On May 6th, 2005 the Center for Medicare and Medicaid Services (CMS), dept of Health and Human Services, issued a policy/document designed to prevent fraudulent billing for outpatient rehab services incident to physician services.
The ruling states that only licensed physical therapists, occupational therapists, speech therapists, physical therapist assistants or certified occupational therapist assistants (PT/OT/ST or PTA and COTA) and nurse practitioners in special instances will be reimbursed for rehab services.
Unfortunately, lymphedema therapists use rehab-billing codes (CPT codes) to bill for Complete Decongestive Therapy (CDT). This ruling prevents Licensed Massage Therapists and Nurses, specially trained in Lymphedema Therapy, from receiving Medicare reimbursement for CDT. This ruling applies specifically to a physician's service that has LMT's and nurses on staff. See http://www.cms.hhs.gov/providerupdate/physicians.asp and click on #34 to review this new policy.
This means that Medicare is authorized to pay only for rehabilitation services (which includes CDT) provided by licensed physical/occupational therapists, even if they are not trained/certified LE therapists.
The National Lymphedema Network's mission includes securing adequate insurance coverage for medically safe and effective treatment for all patients with LE and related disorders. The NLN supports lymphedema therapists in all disciplines who have taken a lymphedema training program that provides a minimum of 135 hours of intensive training. The number of certified lymphedema therapists in the US is limited and this ruling effectively eliminates a significant number of experienced practitioners (LMT's and RN's) from providing reimbursable services to Medicare recipients. Patients in need of appropriate, safe, and effective lymphedema treatment may be unable to find a qualified practitioner to treat them if this ruling remains in effect.
We urge you to contact/write your local and state legislators immediately to make them aware of your concerns. (See Sample Letter.) For more information, contact the Lymphedema Stakeholders - A Public Action Coalition.
Lymphedema therapists should contact their professional organizations to organize support to amend this ruling. Be prepared to provide written documentation of your services and results of case studies to document the efficacy of treatment.