Introduction The Centers for Medicare & Medicaid Services (CMS) has issued an update to the Medicare Benefit Policy Manual, specifically addressing Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) and the inclusion of lymphedema compression treatment items. These changes aim to clarify benefit category determinations and introduce new coverage for lymphedema treatments.

Key Changes

1. DMEPOS Benefit Category Determinations
   • Effective from October 1, 2023, updates are made to Section 110.8 regarding DMEPOS benefit categories.
   • This includes updated guidelines for determining which items qualify under the DMEPOS benefit category.
2. Lymphedema Compression Treatment Items
   • Effective from January 1, 2024, new Section 145 introduces coverage for lymphedema compression treatment items.
   • Coverage includes various items such as standard and custom gradient compression garments, wraps, and bandaging supplies.
   • Items must be prescribed by a physician and supplied by an enrolled DMEPOS supplier.
   • Specific categories covered include daytime and nighttime garments, compression wraps, and necessary accessories.
   • Replacement and frequency limitations for these items are also outlined to ensure reasonable and necessary use.

Implementation and Education

• The implementation date for these changes is May 6, 2024.
• CMS will provide educational content to providers through the Medicare Learning Network® (MLN) and other channels to ensure a smooth transition and compliance with the new guidelines.

Conclusion These updates aim to enhance clarity and expand coverage for essential medical supplies and treatments under Medicare, ensuring beneficiaries receive necessary care while maintaining compliance with updated regulatory standards.