The USMCA compiled a list of common questions ranging from what’s covered by insurance to the HCPCS codes.
Where can I read the final rule?
Access the final rule (PDF).
Where can I find the HCPCS code list?
View the code list on the HCPCS website.
Will the HCPCS change for commercial insurance?
HCPCS are generally adopted as the standard across most payers. But individual commercial insurance plans may decide to still use the S codes, which will be invalid for Medicare use.
When will the fee schedule be published?
View the fee schedule.
Will lymphedema compression treatment items be placed in the Competitive Bidding Program?
CMS has the authority to do so, but has not yet elected to use this authority now or in the near future.
Do I have to be DMEPOS enrolled to bill Medicare?
Yes.
Can clinicians become DMEPOS suppliers?
Yes.
I have a question about DMEPOS enrollment. Where do I get answers?
Get answers about enrollment here.
When is CMS going to update the DMEPOS enrollment process to reflect lymphedema compression items and supplies?
Please contact the National Provider Enrollment contractors with questions.
Where do I find DMEPOS enrolled suppliers?
Medicare.gov provides an online tool for finding enrolled suppliers.
I have a question about how to bill Medicare. Where do I find answers?
Please contact the DME MAC in your geographical jurisdiction. Find the contact info for your jurisdiction.
I have a question about how to bill a Medicare patient. Where do I find answers?
Please contact the DME MAC in your geographical jurisdiction. Find the contact info for your jurisdiction.
For additional informaton, visit the Noridian website.
I have a question about ABNs. Where do I find answers?
Learn more about ABNs through the Medicare Learning Network.
I have a question about how to bill other insurance plans or patients with insurance plans other than Medicare. Where do I find answers?
Please contact the specific payer’s claims and billing department.
What about compression bras?
There were three HCPCS codes published with bra in the description:
- A6528 Gradient compression garment, bra, for nighttime use, each
- A6529 Gradient compression garment, bra, for nighttime use, custom, each
- A6589 Gradient pressure wrap with adjustable straps, bra, each
Will all brands of products be covered?
Medicare has not identified specific brands for coverage.
Will products be sold in pairs or units?
CPCS are labeled as “each”, so they must be billed as individual units.
Is Medicare paying a separate fitting fee?
No. DMEPOS suppliers are responsible for all aspects of furnishing the item, including fitting, and measuring services.
Will phlebolymphedema and/or lipedema be covered?
CMS stated “we are finalizing the proposed rule to limit the scope of the new benefit for lymphedema compression treatment items to items furnished to an individual with a diagnosis of lymphedema and not illnesses other than lymphedema.”
What is Medicare going to cover?
See CMS’s list of covered Lymphedema Compression Treatment Items
View the joint publication from DME MACs
How will this impact Medicare Advantage coverage?
Medicare Advantage Plans must cover all medically necessary services that Original Medicare covers. In many cases, you may need to get approval from your plan before it covers certain services or supplies. Contact the specific plan if you have questions about covered services.
How will this impact other commercial insurance plan coverage?
Commercial plans may choose to use the policies and guidelines Medicare publishes, or they may choose to use their own versions. Contact the specific plan if you havevquestions about covered services.