Medicare Coverage for Lymphatic Therapy: What You Need to Know
Does Medicare Pay for Lymphatic Therapy?
Medicare provides coverage for lymphatic therapy, but only under specific conditions. Understanding these requirements is crucial.
Medicare Reimburses for Two Main Types of Therapy:
- Manual Lymphatic Drainage (MLD): Gentle massage to move fluid.
- Comprehensive Decongestive Therapy (CDT): A combination of MLD, bandaging, skin care, and exercises.
Coverage Requirements Include:
- A documented diagnosis of lymphedema. Other causes like chronic venous insufficiency are not covered, making proper diagnosis essential.
- Evidence of prior unsuccessful therapies, such as elevation or diuresis. Clinicians must document earlier efforts.
- Services provided by a qualified clinician under accepted medical standards. Unqualified individuals cannot provide reimbursable care, emphasizing the importance of choosing the right provider.
Limitations:
- Treatment aims to empower patients or caregivers to manage care independently within 1-3 weeks. Treatments beyond this timeframe require special justification, necessitating clear documentation of ongoing needs.
- Skilled care must show improvement within 7-10 days. If the patient can manage independently, the care is no longer reimbursable, often transitioning to home care as the end goal.
Medicare supports necessary and effective lymphatic therapy when delivered by qualified providers and documented appropriately.
How Do I Know If a School Is Certified to Provide Lymphatic Therapy?
Selecting a certified school for lymphatic therapy is critical for proper training. While the process may seem straightforward, there are essential factors to verify:
- Accreditation: The school should be accredited by the Lymphology Association of North America (LANA). Checking the accreditation status ensures the institution aligns with professional standards.
- Training Hours: A comprehensive program requires at least 135 training hours to meet Certified Lymphedema Therapist (CLT) certification criteria. Schools offering fewer hours do not meet these standards.
- Certification Outcome: Upon completing training, the school must provide a CLT certificate. Without it, graduates cannot demonstrate they are fully qualified lymphatic therapists.
By focusing on accreditation, training hours, and certification outcomes, you can ensure the school meets the necessary standards for quality education.
Do Physical or Occupational Therapists Need Additional Certification to Provide Manual Lymphatic Drainage?
Physical and occupational therapists can generally provide manual lymphatic drainage (MLD) without additional certification. However, certain conditions may apply:
- State Licensure: MLD must fall within the therapist’s state-defined licensure. Always check local regulations.
- Adequate Training: Therapists must demonstrate adequate training to perform MLD safely and effectively. Ongoing education ensures quality care.
- Medical Necessity: MLD must be medically necessary and documented in a treatment plan. Proper documentation ensures reimbursement.
Key Considerations:
- Medicare does not require certification to bill for MLD under CPT code 97140. However, clinics or employers might.
- Therapists should evaluate their goals and clinical settings when deciding on certification.
In summary, while additional certification is not mandatory, it can provide significant advantages in certain clinical contexts.
Is Comprehensive Decongestive Therapy (CDT) Included in Lymphatic Therapy Certification?
Comprehensive Decongestive Therapy (CDT) is a cornerstone of lymphedema treatment, combining techniques like Manual Lymphatic Drainage (MLD), bandaging, skin care, and therapeutic exercises. Certification for CDT is often included in lymphatic therapy courses but depends on the program's structure. Here's what you need to know:
- Part of Lymphatic Therapy Training: Accredited courses, such as those certified by the Lymphology Association of North America (LANA), typically include CDT as part of their curriculum. These programs ensure you learn all aspects of CDT to meet the requirements for becoming a Certified Lymphedema Therapist (CLT).
- Additional Focus on CDT: While CDT is included, some courses may offer specific modules or extra training hours focused on CDT techniques, especially for advanced cases of lymphedema.
- Certification Requirements: To earn a CLT certificate, students must complete a minimum of 135 hours of training, which usually encompasses CDT and MLD techniques.
If you're considering a career in lymphedema care, verify with your chosen program that CDT is part of the course. This ensures you're fully prepared to meet the demands of comprehensive lymphedema treatment.
Can a Massage Therapist Bill Medicare for Lymphatic Therapy?
No, massage therapists cannot bill Medicare for lymphatic therapy. Here’s why:
- Medicare Exclusion: Medicare does not cover massage therapy, including lymphatic drainage, when provided by massage therapists.
- Qualified Providers: Licensed healthcare providers like physical and occupational therapists can bill Medicare for MLD, provided they meet conditions such as medical necessity and valid care plans.
Massage therapists lack the qualifications Medicare recognizes for billing MLD. Patients needing lymphatic therapy should seek care from approved professionals to ensure coverage.
References
- Federal Register (FR), Volume 76, Number 228, Part III, Section C-5
- Internet Only Manual (IOM) Medicare National Coverage Determinations Manual, Publication 100-03, Chapter 1, Part 4, Sections 270.5, 280.1, 280.6
- IOM Medicare Benefit Policy Manual, Publication 100-02, Chapter 15, Sections 220-230
- IOM Medicare Claims Processing Manual, Publication 100-04, Chapter 5, Section 20(B)
- Current Procedural Terminology Coding Manual
- Social Security Act (SSA), Title 18, Section 1862(a)(1)(A)
- Noridian article titled "Medical Necessity of Therapy Services"
- Noridian article titled "High Compression Bandage System Clarification"