Billing & Coding Resources

Billing & Coding Resources for Lymphedema Care

This page provides essential billing and coding information for lymphedema treatment and compression garment services.

Lymphedema Treatment Act

Information about the Lymphedema Treatment Act and state-by-state coverage for compression garments and supplies.

Lymphedema Treatment Act Summary

Lymphedema Treatment Act link

Medicare Documentation Resources

Medicare Therapy Billing and Documentation Requirements

Above is a direct link to Medicare.Gov site. Good luck its long.

HINT: when you get to the site, click control F and then type in search box 220.3.

• Documentation Rules - Medicare requirements for proper documentation
• 8-Minute Billing Rule - Time-based billing guidelines for therapy services
• Required Documentation - Evaluation, treatment, and discharge documentation standards

ICD-10 Codes

Common diagnosis codes for lymphedema documentation and billing.

• I89.0: Lymphedema, not elsewhere classified (most common).
• I97.2: Postmastectomy lymphedema syndrome.
• Q82.0: Hereditary lymphedema.
• I89.1: Lymphedema following mastectomy (also used for post-surgical complications).
• I97.89: Other postprocedural complications and disorders of the circulatory system.
• I87.2: Venous insufficiency (chronic) of the lower extremity (if lymphedema is associated)

CPT Codes

Common CPT codes for lymphedema treatment (PT/OT) focus on Complete Decongestive Therapy (CDT), including manual lymphatic drainage, compression, and exercises.

Key codes include:

• 97140 - Manual Therapy Techniques: Used for Manual Lymphatic Drainage (MLD) and myofascial release, requiring one-on-one, direct patient contact.
• 97110 - Therapeutic Exercises: Used for exercises to improve lymphatic flow.
• 97535 - Self-Care/Home Management Training: Used for training in self-bandaging, skincare, and garment management.
• 29581/29584 - Application of Multi-Layer Compression System: Used for applying compression bandages to extremities (29581 for lower extremity, 29584 for upper/lower).
• 97760 - Orthotic Management and Training: Used for measuring, fitting, and training in compression garments.
• 97016 - Vasopneumatic Devices: Used for pneumatic compression pumps. THIS IS UNTIMED so it is easily added to a treatment note. I still prefer to leave a few minutes in your time in and out to allow for pump time. Remember, you are always educating and assessing while setting up etc. to keep your time billable. 

Key Considerations:

• Billing for MLD: 97140 is the primary code for MLD.
• Compression Bandaging: While 29581/29584 are used, Medicare often considers this an unskilled service, though 97535 (self care) can be used for educating the patient on self-bandaging.
• Skin Care: Cleansing and applying lotion to extremities during MLD can be included in 97140.