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LTA - COMPRESSION GARMENTS & WRAPSLYMPHEDEMA PUMP (Pneumatic Compression Device)

LYMPHEDEMA TREATMENT ACT (LTA) - COMPRESSION GARMENTS & WRAP

  • Forms and resources for ordering compression garments and wraps for patient's with Lymphedema. Medicare now covers:
  •  3 daytime pair of wraps or garments every 6 months (per effected body part)
  •  Nighttime garments = 2 garments every 2 years per affected body part (defined by HCPCS codes)
  • Accessories are covered on a case-by-case review and what we traditionally call 'options' are defined as 'Accessories' by Medicare (i.e. custom lymph pads, silk lining, butler application device)
  • Patient's MUST have at least one of the four Lymphedema Diagnosis codes in their medical records/Rx

LYMPHEDEMA TREATMENT ACT (LTA) OVERVIEW (pdf)

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LYMPHEDEMA TREATMENT ACT | medi Product Selection Guide (pdf)

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Circaid Reduction Kit Trim-to-Fit Bandages (pdf)

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medi Lymphatic System Poster - (pdf)

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medi Night Garments | circaid profile (pdf)

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medi Flat-Knit Custom Measuring & Options Fitting Guide (pdf)

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Custom-flat-knit-and-circaid-profile-lower-extremity_order-form_P0240_Rev-R (pdf)

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Custom-circaid-lower-extremity_order-form_P0175_Rev-F (pdf)

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Custom_Compression-for-Lymphedema_order-form_P0899 (pdf)

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circaid-reduction-garments_order-form_P1515_Rev-I (pdf)

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circaid-upper-extremity_Order-form_P0174_Rev-G (pdf)

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Custom-flat-knit-and-circaid-profile-upper-extremity_order-form_P0241_Rev-N-2 (pdf)

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Flat-knit-toe-caps_order-form_P0242_Rev-P (pdf)

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Lymphedema-ready-to-wear_order-form_E1419 (pdf)

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PNEUMATIC COMPRESSION DEVICE (E0651 / E0652)

  • Forms and resources for ordering a Pneumatic Compression Device (PCD), used for Lymphedema Patients. Also known as a Lymphedema Pump to move lymphatic fluid in the lower and upper extremities. 
  • Patient must have a lymphedema diagnosis & complete a 4-week trial of conservative therapy: compression therapy, elevation, exercise, and have measurements taken to track volume/size changes

LYMPHEDEMA PUMP - REQUIREMENT CHECKLIST (pdf)

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LEG MEASUREMENT RECORD FORM (pdf)

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LOWER EXTREMITY - LYMPHEDEMA PUMP ORDER FORM/Rx (pdf)

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E0651 PUMP DOCUMENTATION TIMELINE & GUIDE (pdf)

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Medicare/Noridian Online Checklist & Guide (pdf)

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medi Brio & Genius Lymphedema Pump Brochure (pdf)

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medi Managing Lymphedema Trifold Brochure (pdf)

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