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Financial Assistance for Compression Garments
8th NLN Conference, August 27-31, 2008, San Diego CA
Groundbreaking Medicare Decision:
Compression Garments are Prosthetic Devices!
New Book: 4th ed, Lymphedema: Diagnosis and Therapy, H. Weissleder
For Professionals: NLN Research Survey
Updated NLN Online Patient Questionnaire
NLN Position Papers: Risk Reduction, Treatment, Exercise, Air Travel, Training
Seeking Patients: Breast Cancer Survivor Studies
The lymphedema spotlight is on New York this spring, where there are eleven bills currently being considered by the State Legislature. Assemblyman Alan Maisel has picked up the torch lit by Assemblywoman Adele Cohen in 2003 and is carrying forward her comprehensive lymphedema treatment bill as well as a quartet of lymphatic research, registry and outreach bills originated by the Lymphatic Research Foundation.
NY A07077 Maisel/S01544 Fuschillo
LE diagnosis and treatment bills two of the11 bills currently in the New York Legislative chambers, 6 in the Assembly and 5 in the Senate. Assembly bill A07077/S01544 are comprehensive diagnosis and treatment bills which include an informed consent provision and a provision conforming New York law with the lymphedema treatment provision of the Women's Health and Cancer Rights Act (WHCRA) of 1998.
Other New York Lymphedema-related bills are:
NY A02823 Kolb
Requires insurance policy providers to provide coverage for the diagnosis and treatment of lymphedema, including the cost of compression sleeves;
NY A05889 Maisel/S04266 Golden
Creates the lymphedema and lymphatic diseases research grants program;
NY A05890 Maisel/S04267 Golden
Creates the lymphedema and lymphatic diseases research and education fund;
NY A05891 Maisel/S03252 Fuschillo
Requires physicians to report cases of lymphedema to the department of health and creates the lymphedema and lymphatic diseases registry and advisory board;
NY A05892 Maisel/S03248 Fuschillo
Requires the commissioner of health to investigate lymphedema and the treatment available and requires physicians to notify the department of health of cases of lymphedema.
CA AB-213 Liu
passed the Assembly Health Committee in 2006, but was pulled after a last-minute move by the Association of Northern California Oncologists (ANCO) to emasculate it prior to being presented to the Appropriations Committee. We are searching for a new sponsor for re-introducing the bill this year.
GA HB1011 Buckner
is a bill establishing a 5-year pilot program of preventive lymphedema treatment for Georgia employees, with an evaluation of the costs and savings and a recommendation by 2011 for the extension of the program to Medicaid beneficiaries.
GA HR1055 and GA HR1056 Buckner
are resolutions which passed the Georgia Assembly which recommend that medical providers refer lymphedema patients to certified lymphedema therapists, and that medical and health educational institutions include lymphedema diagnosis and treatment in their curricula.
MA SB00586 Fargo
Comprehensive lymphedema treatment bill in the Massachusetts Senate.
MA SB01327 Spilka
Massachusetts Senate bill to conform Massachusetts law to the WHCRA of 1998 including the lymphedema treatment provision.
CT HB 5303 O'Connor
Connecticut bill for lymphedema supplies.
VA HB 1737 Wardrup
Virginia lymphedema treatment law, passed 2003 is the first and only state law providing lymphedema diagnosis and treatment with coverage for compression therapy supplies.
Meeting at CMS on Coding of Lymphedema Garments
At last year's October meeting with the HCPCS Workgroup of CMS (LYMPHLink Vol. 19, No. 1 Jan-Mar 2007), I was told of the formal process for changing HCPCS Codes. In accordance with that process a formal request was sent to establish a series of new codes for the full range of prosthetic devices and supplies used in the treatment of lymphedema from all causes. This request encompasses compression bandaging or binding systems, compression garments, compression devices and directional flow pads and garments. The request would add more than 100 new codes for items used in the treatment of lymphedema and to identify them as “prosthetic devices and supplies” (LXXXX codes). The request would restore the lymphedema lower limb compression stockings to the prosthetic devices grouping from which they were recently removed. It was also requested that CMS recode the lymphedema upper limb compression sleeves from “uncovered codes” S8420-S8431 to “coverable” LXXXX codes.
My request pointed out that medical items commonly prescribed in the compression therapy for lymphedema include compression bandaging or binding systems, compression garments, compression devices for producing the prescribed compression, pressure and directional flow pads and garments used in conjunction with compression devices. Some of these items are already listed in the HCPCS code set, but are categorized in benefit categories that do not apply to the medical function served in their treatment of lymphedema. The items already listed include various bandage types covered as surgical dressings, and graduated compression stockings, covered as secondary surgical dressings, both under §1861(s)(5) of the Social Security Act (SSA). The new codes would identify the full range of products used in lymphedema treatment, and would be assigned to the prosthetic procedures HCPCS codes corresponding to the “prosthetic devices” benefit category defined by §1861(s)(8) of the SSA.
This request is in full consonance with two recent Medicare Administrative Law Judge decisions that held that the compression sleeves and gloves, bandages, directional flow sleeves, graduated compression stockings and visits to a therapist for fitting of the custom garments were all covered as prosthetic devices and supplies, and related services according to the SSA.
The CMS HCPCS Workgroup Preliminary Decision was to deny the request on the basis that “No insurer (i.e., Medicare, Medicaid, Private Insurance Sector) identified a national program operating need to establish unique codes to distinguish all the products listed in this application.” and “Existing codes adequately describe the array of products available.”
These issues were addressed by this writer and Nicole Gergich at a public meeting at CMS in Baltimore on May 1, 2007 . (See attached photo) If we are successful, we go on to Tier 2 of the process, which will determine whether new codes are created, existing codes used or "miscellaneous" codes continue to be used. The final answer will be issued by November 2007, effective Jan 1, 2008 . But in any case, listing in the HCPCS Code Book does not confer coverability. The issue of whether these bandages, garments and devices are covered by Medicare must still be worked with the CMS Coverage and Analysis Group. This topic was informally raised with CMS by this writer and Dr. Wade Farrow last October.
Robert "Bob" Weiss, M.S.
NLN LE Legislative Advocate
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