I 

112TH CONGRESS 

1ST SESSION H. R. 2499 

To amend title XVIII of the Social Security Act to improve the diagnosis 

and treatment of lymphedema under the Medicare program and to reduce 

costs under such program related to the treatment of lymphedema. 

IN THE HOUSE OF REPRESENTATIVES 

JULY 12, 2011 

Mr. KISSELL (for himself, Mr. ROE of Tennessee, Mr. PAUL, Mr. BLUMENAUER, Mr. RANGEL, Ms. BROWN of Florida, Mr. COBLE, Mr. HOLT, 

Ms. RICHARDSON, Mr. CONNOLLY of Virginia, Mr. MICHAUD, Ms. 

MOORE, Mr. JACKSON of Illinois, Ms. NORTON, Mr. MILLER of North 

Carolina, Mr. FRANK of Massachusetts, Mr. SCHIFF, and Mr. PRICE of 

North Carolina) introduced the following bill; which was referred to the 

Committee on Energy and Commerce, and in addition to the Committee 

on Ways and Means, for a period to be subsequently determined by the 

Speaker, in each case for consideration of such provisions as fall within 

the jurisdiction of the committee concerned 

A BILL 

To amend title XVIII of the Social Security Act to improve 

the diagnosis and treatment of lymphedema under the 

Medicare program and to reduce costs under such program related to the treatment of lymphedema. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 


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1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Lymphedema Diag3 nosis and Treatment Cost-Saving Act of 2011’’. 

4 SEC. 2. COVERAGE OF LYMPHEDEMA DIAGNOSIS AND 

5 TREATMENT SERVICES UNDER MEDICARE. 

6 (a) COVERAGE OF SERVICES.—Section 1861 of the 

7 Social Security Act (42 U.S.C. 1395x) is amended— 

8 (1) in subsection (s)(2)— 

9 (A) in subparagraph (EE), by striking 

10 ‘‘and’’ at the end; 

11 (B) in subparagraph (FF), by adding 

12 ‘‘and’’ at the end; and 

13 (C) by adding at the end the following new 

14 subparagraph: 

15 ‘‘(GG)(i) lymphedema diagnosis services 

16 (as defined in subsection (iii)(1)) and 

17 lymphedema treatment services (as described in 

18 subsection (iii)(2)); and 

19 ‘‘(ii) lymphedema compression treatment 

20 items (as defined in subsection (jjj)).’’; and 

21 (2) by adding at the end the following new sub22 sections: 

23 ‘‘(iii) LYMPHEDEMA DIAGNOSIS AND TREATMENT

24 SERVICES.—(1) LYMPHEDEMA DIAGNOSIS SERVICES.— 

25 The term ‘lymphedema diagnosis services’ means, with re26 spect to an individual, the differential diagnosis of the 


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1 source of the individual’s edema and the identification of 

2 the specific etiology and functional lymphatic deficiency, 

3 in which such diagnosis— 

4 ‘‘(A) is provided by a provider, as defined in 

5 paragraph (3), for the purpose of developing a 

6 lymphedema treatment plan; and 

7 ‘‘(B) may utilize any diagnostic tools the pro8 vider determines to be reasonable and necessary. 

9 ‘‘(2) LYMPHEDEMA TREATMENT SERVICES.—The 

10 term ‘lymphedema treatment services’ means, with respect 

11 to an individual, services for the treatment of lymphedema 

12 (regardless of cause)— 

13 ‘‘(A) that are— 

14 ‘‘(i) provided in an inpatient or outpatient 

15 setting; 

16 ‘‘(ii) provided by a provider, as defined in 

17 paragraph (3), within the established scope of 

18 practice of such provider; and 

19 ‘‘(iii) medically necessary, in accordance 

20 with the current standard of lymphedema treat21 ment, including complete decongestive therapy, 

22 which is a multi-modal therapy comprising of 

23 manual lymph drainage, compression therapy 

24 utilizing multilayer bandage systems, compres25 sion garments and devices, exercise, skin care, 


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1 patient education, and any other lymphedema 

2 treatment modalities determined by the Sec3 retary to be safe and effective; and 

4 ‘‘(B) which shall— 

5 ‘‘(i) include as medically necessary with re6 spect to the individual— 

7 ‘‘(I) an initial evaluation and course 

8 of clinical treatment, including initial base9 line measurements and subsequent meas10 urements to assess treatment efficacy and 

11 progress; 

12 ‘‘(II) follow-up courses of clinical 

13 treatment; 

14 ‘‘(III) in the case that such individual 

15 has cancer, clinical measurements, includ16 ing initial pre-operative baseline measure17 ments and periodic subsequent measure18 ments to diagnose the presence of 

19 lymphedema; and 

20 ‘‘(IV) any other treatment modality 

21 approved by the Secretary; and 

22 ‘‘(ii) be provided in accordance with such 

23 schedule, duration, and number of treatments 

24 as determined medically necessary. 


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1 ‘‘(3) PROVIDER DEFINED.—For purposes of this sub2 section and subsection (jjj), the term ‘provider’ means any 

3 licensed medical or health care provider whose State li4 censing board recognizes lymphedema diagnosis, 

5 lymphedema treatment, or both to fall within the scope 

6 of practice of such medical or health care provider. 

7 ‘‘(jjj) LYMPHEDEMA COMPRESSION TREATMENT

8 ITEMS.—The term ‘lymphedema compression treatment 

9 items’ means, with respect to an individual, compression 

10 garments, devices, bandaging systems, components, and 

11 supplies that are primarily and customarily used in the 

12 medical treatment of lymphedema of the arms, hands, 

13 legs, feet, torso, face and neck, breast and chest, abdomen, 

14 and genitalia, as prescribed by a provider, as defined in 

15 subsection (iii)(3). Such term includes— 

16 ‘‘(1) multilayer compression bandaging systems, 

17 including short-stretch and medium-stretch compres18 sion bandages; cotton, synthetic, or foam padding; 

19 gauze or elastic finger and toe bandages; foam pads; 

20 directional flow padding; and tubular bandages; 

21 ‘‘(2) custom or standard fit gradient compres22 sion garments; 

23 ‘‘(3) non-elastic and low-elastic compression 

24 garments, manually adjustable or fitted padded di25 rectional flow garments (with or without elastic or 


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1 non-elastic compression jackets) and compression 

2 wraps and directional flow pads; 

3 ‘‘(4) aids and ancillary equipment consisting of 

4 donning aids, bandage rollers, shoes to fit over com5 pression items, and other specialized items used with 

6 the items described in paragraphs (1) through (3); 

7 ‘‘(5) pneumatic appliances connected to and 

8 used in conjunction with pneumatic sequential com9 pression controllers; 

10 ‘‘(6) any other compression garments, ban11 daging systems, devices, and aids determined by the 

12 Secretary to be effective in the prevention or treat13 ment of lymphedema; and 

14 ‘‘(7) replacements of any items under this sub15 section in accordance with section 1834(p)(3).’’. 

16 (b) PAYMENT.— 

17 (1) LYMPHEDEMA COMPRESSION TREATMENT

18 ITEMS.— 

19 (A) IN GENERAL.—Section 1833(a) of 

20 such Act (42 U.S.C. 1395l(a)) is amended— 

21 (i) in paragraph (8), by striking at 

22 the end ‘‘and’’; 

23 (ii) in paragraph (9), by striking at 

24 the end the period and inserting a semi25 colon; and 


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1 (iii) by adding at the end the fol2 lowing new paragraph: 

3 ‘‘(10) in the case of lymphedema compression 

4 treatment items described in section 1861(jjj), the 

5 amount determined under section 1834(p); and’’. 

6 (B) PAYMENT DETERMINED.—Section 

7 1834 of such Act (42 U.S.C. 1395m) is amend8 ed by adding at the end the following new sub9 section: 

10 ‘‘(p) PAYMENT FOR LYMPHEDEMA COMPRESSION

11 TREATMENT ITEMS.— 

12 ‘‘(1) GENERAL RULE FOR PAYMENT.— 

13 ‘‘(A) IN GENERAL.—With respect to a 

14 lymphedema compression treatment item as de15 fined in section 1861(jjj)) for which payment is 

16 determined under this subsection, subject to 

17 subparagraph (D), payment shall be made in an 

18 amount equal to 80 percent of the payment 

19 basis described in subparagraph (B). 

20 ‘‘(B) PAYMENT BASIS.—The payment 

21 basis described in this subparagraph, with re22 spect to a lymphedema compression treatment 

23 item described in section 1861(jjj), is the actual 

24 charge for the item. 


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1 ‘‘(C) EXCLUSIVE PAYMENT RULE FOR

2 HOME HEALTH AGENCIES.—Notwithstanding 

3 any other provision of this title, this subsection 

4 shall constitute the exclusive provision of this 

5 title for payment for lymphedema compression 

6 treatment items described in section 1861(jjj) 

7 under this part or under part A to a home 

8 health agency or for such items that are fur9 nished as an incident to a physician’s profes10 sional service. 

11 ‘‘(2) ALLOWABLE QUANTITIES.—In the case it 

12 is determined by a provider, as defined in section 

13 1861(iii)(3), that lymphedema compression treat14 ment items are required as part of lymphedema 

15 treatment services under section 1861(iii)(2), then 

16 payment may be made under this title in accordance 

17 with this subsection for such items in the quantity 

18 which is customary, reasonable, and medically nec19 essary. 

20 ‘‘(3) REPLACEMENT OF LYMPHEDEMA COM21 PRESSION TREATMENT ITEMS.— 

22 ‘‘(A) IN GENERAL.—Payment shall be 

23 made under this subsection, with respect to an 

24 individual, for the replacement of a 

25 lymphedema compression treatment item if the 


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1 period of the reasonable and useful lifetime of 

2 the item (as described in subparagraph (B)) 

3 has expired or a provider, as defined in section 

4 1861(iii)(3), determines that a replacement, or 

5 repair, of such item, is medically necessary. 

6 ‘‘(B) REASONABLE AND USEFUL LIFE7 TIME.—For purposes of subparagraph (A), the 

8 period of the reasonable and useful lifetime of 

9 a lymphedema compression treatment item is as 

10 follows: 

11 ‘‘(i) In the case of any item described 

12 in section 1861(jjj)(1), 1 year. 

13 ‘‘(ii) In the case of any item described 

14 in section 1861(jjj)(2), 6 months. 

15 ‘‘(iii) In the case of any item de16 scribed in section 1861(jjj)(3), 2 years. 

17 ‘‘(iv) In the case of any item described 

18 in section 1861(jjj)(4), 1 year. 

19 ‘‘(v) In the case of any item described 

20 in section 1861(jjj)(5), 5 years. 

21 ‘‘(vi) In the case of any item described 

22 in section 1861(jjj)(6), such period as de23 termined by the Secretary, in consultation 

24 with appropriate health organizations, at 

25 the time the Secretary determines such 


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1 item to be effective in the prevention or 

2 treatment of lymphedema.’’. 

3 (C) APPLICATION OF SUPPLIER REQUIRE4 MENTS.—Section 1834(j)(5) of such Act (42 

5 U.S.C. 1395m(j)(5)) is amended— 

6 (i) in subparagraph (E), by striking 

7 at the end ‘‘and’’; 

8 (ii) in subparagraph (F), by striking 

9 at the end the period and inserting ‘‘; 

10 and’’; and 

11 (iii) by adding at the end the fol12 lowing new subparagraph: 

13 ‘‘(G) lymphedema compression treatment 

14 items (as defined in section 1861(jjj)).’’. 

15 (2) LYMPHEDEMA DIAGNOSIS AND TREATMENT

16 SERVICES.— 

17 (A) IN GENERAL.—Section 1833(a) of 

18 such Act, as amended by paragraph (1)(A), is 

19 further amended by adding at the end the fol20 lowing new paragraph: 

21 ‘‘(11)(A) in the case of lymphedema diagnosis 

22 services (as defined in section 1861(iii)(1)) furnished 

23 by a provider (as defined in section 1861(iii)(3)) the 

24 amount described in section 1834(q); and 


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1 ‘‘(B) in the case of lymphedema treatment serv2 ices (as defined in section 1861(iii)(2)) furnished by 

3 a provider (as defined in section 1861(iii)(3)) the 

4 amount described in section 1834(k).’’. 

5 (B) PAYMENT METHOD.—Section 1834 of 

6 such Act, as amended by paragraph (1)(B), is 

7 further amended by adding at the end the fol8 lowing new subsection: 

9 ‘‘(q) PAYMENT FOR OUTPATIENT LYMPHEDEMA DI10 AGNOSIS AND TREATMENT SERVICES BY PHYSICIANS AND

11 NON-PHYSICIAN PRACTITIONERS.— 

12 ‘‘(1) IN GENERAL.—For purposes of section 

13 1833(a)(11), the amount described in this sub14 section, with respect to a lymphedema diagnosis 

15 service or lymphedema treatment service, is 80 per16 cent of the lesser of— 

17 ‘‘(A) the actual charge for the service; or 

18 ‘‘(B) the applicable fee schedule amount 

19 (as defined in paragraph (2)) for the service. 

20 ‘‘(2) APPLICABLE FEE SCHEDULE AMOUNT.— 

21 In this subsection, the term ‘applicable fee schedule 

22 amount’ means, with respect to services furnished in 

23 a year, the amount determined under the fee sched24 ule established under section 1848 for such services 

25 furnished during the year.’’. 


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1 (C) CONFORMING AMENDMENT FOR PAY2 MENTS UNDER 1834(k).—Section 1834(k)(1) of 

3 such Act (42 U.S.C. 1395m(k)(1)) is amended 

4 by striking ‘‘or 1833(a)(9)’’ and inserting 

5 ‘‘1833(a)(9), or 1833(a)(11)’’. 

6 (c) EFFECTIVE DATE.—The amendments made by 

7 this section shall apply to items and services furnished on 

8 or after the date that is 180 days from the date of the 

9 enactment of this Act. 

Æ 


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