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)

LYMPHEDEMA TREATMENT ACT | medi Product Selection Guide (pdf)

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

medi Lymphatic System Poster - (pdf)

medi Night Garments | circaid profile (pdf)

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

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

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

Custom_Compression-for-Lymphedema_order-form_P0899 (pdf)

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

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

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

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

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

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)

LEG MEASUREMENT RECORD FORM (pdf)

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

E0651 PUMP DOCUMENTATION TIMELINE & GUIDE (pdf)

Medicare/Noridian Online Checklist & Guide (pdf)

medi Brio & Genius Lymphedema Pump Brochure (pdf)

medi Managing Lymphedema Trifold Brochure (pdf)