The March update to this Joint DME MAC Correct Coding and Billing article has caused some misunderstanding within the field. Under “Documentation Requirements,” the article states that to support Medicare coverage, the medical record must include:

“Diagnosis of lymphedema documented by the treating practitioner (MD, DO, NP, PA, CNS) in the beneficiary’s medical record.”

Some misinterpreted this to mean the MD must complete all of the documentation requirements, which is not the case. While the MD must document the diagnosis of lymphedema, additional medical necessity may be captured by other sources, per the Standard Documentation Requirements article.

The DME MACs jointly published a billing and coding article with guidance pertinent to lymphedema compression treatment items, including proper use of four modifiers that will go into effect for claims with dates of service on or after Jan. 1, 2026. You can find out which modifiers are required for a specific HCPCS code via the Modifier tools found on both the CGS and Noridian websites (make sure you’re viewing your correct jurisdiction for the tool). Read the full articles from Noridian and CGS.

Final Rule CMS-1828-F includes updates to the Competitive Bidding Program (CBP) and other provisions related to provider enrollment and prior authorization. CMS expects to implement the next round of the CBP by Jan. 1, 2028 (view the proposed timeline). Also, CMS has expanded its authority to monitor, audit, suspend or revoke accreditation status of poorly performing Accredited Organizations (AO) or non-compliant suppliers. For DMEPOS suppliers, the accreditation cycle will shift from every three years to annually. Review the CMS fact sheet or contact your specific AO with questions.