Edema is the swelling of subcutaneous tissues due to the accumulation of excessive fluid. Many items may be used in an attempt to provide treatment. Medicare limits reimbursement to pneumatic compression devices and certain types of multi-component compression bandage systems when the patient meets specified criteria in the Local Coverage Determinations (LCDs) - Pneumatic Compression Devices and Surgical Dressings, respectively.
Other items are non-covered by Medicare when used for the treatment of edema because they do not fall into a statutory benefit category. Some common examples of these non-covered items are (not all-inclusive):
- ReidSleeve (A4465 Non-elastic binder for extremity)
- Jobst mastectomy sleeve (L8010 Breast prosthesis, mastectomy sleeve)
- CircAid (A4465 Non-elastic binder for extremity)
- Isotoner gloves (A9270 Non-covered item or service)
- Compression stockings/leotards (A6530-A6549)
For other items that do not fall within a specific code, A9270 (Non-covered item or service) is the appropriate code to bill to Medicare. Code E1399 (Durable medical equipment, miscellaneous) must not be used for these items.
Consult the DMERC LCDs, SADMERC Product Classification List, or SADMERC Helpline at 877-735-1326 for additional information.
Published by Palmetto GBA as the SADMERC, October 2006. Republished by Noridian as the PDAC, August 2008. Republished by Palmetto GBA as the PDAC, January 2019.
Date Posted 10/27/06