The unfortunate lady in the vintage photograph is Fanny Mills, who was known as “The Ohio Big Footed Girl”. Fanny lived in Sandusky Ohio in the late 1800’s and suffered from Milroy’s Disease, which is a congenital disease that causes lymphedema and generally poor circulation in the lower extremities. There was no treatment for this disorder at the time and Fanny lived with the condition into her 40’s. She eventually succumbed to the disease and her cause of death was listed as “abscess”. The photos were taken when she worked in a dime museum, a place similar to a circus sideshow that featured performers and exhibits of medical oddities. Sadly, her affliction was untreatable at the time. Lymphedema is still around, but thankfully is much more treatable today than in the 19th century!
Lymphedema is defined as “swelling caused by a buildup of lymph fluid in the body, usually in an arm or leg”. Any problem that blocks the normal drainage functionality of the lymphatic system can cause lymphedema. Cancer treatments such as radiation and chemotherapy can damage lymphatic circulation and removal of a tumor often takes lymph nodes with it. Thus, cancer is a fairly common reason why we see lymphedema.
Lymph nodes and the lymphatic system are closely associated with the ability to fight off infection since lymph fluid carries waste products away from the site of an infection and helps remove it from the body. Lymphedema can lead to skin infections and eventually breakdown as well as sepsis and the inability to move or use a limb in extreme cases.
Treatment includes massage, physical therapy, medications, increased skin/wound care as preventive and treatment, and surgery in the most extreme cases. There is also an array of DMEPOS that can be used to treat this problem including various compression stockings and garments, as well as sequential pneumatic pumps. The stockings and garments mentioned look like “sleeves” similar to the Under Armor or Tommie Copper brand sport braces. They are easy to use and effective at treating –or in some cases, preventing—lymphedema.
You may have noticed a lot of recent chatter and buzz about lymphedema and DMEPOS treatments. A new law, The Lymphedema Treatment Act was passed by Congress in late 2022. Effective January 1, 2024, custom fitted lymphedema compression garments and other approved items prescribed by a physician have a new benefit category and are covered! The Susan B. Komen Foundation helped bring this issue to Congress and it is now possible for DME organizations to bill for these items.
So, what does a DME organization need to do if they’d like to provide these items? Here’s a “to do” list for any existing organization that wants to start carrying and billing for these garments:
- Contact suppliers and talk to sales representatives from the companies to see the products that are available. The reps can be excellent resources for learning about the latest equipment and supplies and about how to successfully bill for them.
- Notify CMS of your intent to provide. This is done by revising your CMS 855S form (the equipment list that tells CMS the products and services you are going to provide and bill).
- Notify your accreditation agency. At HQAA, you can simply log in to your account and revise the equipment list by checking off these items.
- Update your policies and procedures. Your scope of service should be revised and you should spell out how the process works when you get a referral for these products.
- Staff education is key to your success with these items and any items you are carrying. Your staff will need to be aware of how the product works and how it’s used. Additionally, staff will have to be educated on how billing and reimbursement works with regards to compression garments.
HCPCS codes to keep in mind include A6545 (gradient compression wraps) and A6531 (gradient compression stockings). The product codes for these garments and devices are:
- DM 18 (Pneumatic Compression Device and Supplies)
- SO 4 (Lymphedema Compression Treatment Items)
There’s a new FAQ update on the CMS website you might want to check out for more detailed information:
Here’s a couple other FAQ sites for good information in your region:
Finally, make sure you have a thorough understanding of billing and reimbursement. Medicare policy has changed significantly regarding this product and it will most likely continue to evolve and change. Check in with your billing staff, a third-party billing company, billing consultant, or any other experts you rely on to see if this product/service is a good fit for your organization. The internet has some great resources available as well. Start with the CMS website and continue your education using Google to search for articles on the products, the changes to the reimbursement and coverage criteria, and other helpful information.
The DME industry is dynamic and ever changing. It takes creativity and open- mindedness to succeed. Know that lymphedema and compression garments are “having their moment” and it might be a good time to look at this product category with an eye toward expanding your scope of services.
