On April 1, the DME MACs provided guidance that clarifies replacement of compression garments used to treat lymphedema. Medicare provides coverage for three compression garments per body area once every six months when the garment is being used to treat lymphedema.
There are potential exceptions to this six-month timeline. Medicare allows an entire new set of three replacement garments if one or more lymphedema compression garment is lost, stolen, suffers irreparable damage, or if there is a change in the patient's condition resulting in the need for a garment of another size. If this replacement occurs, it restarts the six-month clock on another set of replacements.
The RA modifier should be used for the replacement claim if the claim is being submitted because the original(s) were lost, stolen, or irreparably damaged.