I 
111TH CONGRESS 
2D SESSION 
H. R. 4662 
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 complications 
of lymphedema, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
FEBRUARY 23, 2010 
Mr. KISSELL introduced the following bill; which was referred to the Com-
mittee 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 pro-
gram related to the treatment of complications of 
lymphedema, and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Lymphedema Diag-
nosis and Treatment Cost Saving Act of 2010’’. 
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SEC. 2. COVERAGE OF LYMPHEDEMA DIAGNOSIS AND 
TREATMENT SERVICES UNDER MEDICARE. 
(a) COVERAGE OF SERVICES.—Section 1861 of the 
Social Security Act (42 U.S.C. 1395x) is amended— 
(1) in subsection (s)(2)— 
(A) in subparagraph (DD), by striking 
‘‘and’’ at the end; 
(B) in subparagraph (EE), by adding 
‘‘and’’ at the end; and 
(C) by adding at the end the following new 
subparagraph: 
‘‘(FF) lymphedema compression treatment 
items (as described in subsection (iii)) and 
lymphedema diagnosis and treatment services 
(as described in subsection (hhh)) if such serv-
ices are prescribed by and reviewed by a treat-
ing physician and performed by such physician 
or— 
‘‘(i) a physical therapist or an occupa-
tional therapist who meets the quality re-
quirements of subsection (hhh)(2)(C); 
‘‘(ii) a qualified professional, such as 
a physician, nurse practitioner, clinical 
nurse specialist, chiropractor, or physi-
cian’s assistant who is licensed or certified 
by the State in which the services are per-
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formed to perform therapy services and 
who meets the quality requirements of 
(hhh)(2)(C); or 
‘‘(iii) a qualified person, such as a 
physical therapist assistant, occupational 
therapy assistant, licensed massage thera-
pist, licensed practical nurse, or licensed 
home health practitioner who meets the 
quality requirements of (hhh)(2)(C) pro-
viding such services are rendered under the 
direct supervision of a physical therapist or 
occupational 
therapist 
qualified 
in 
lymphedema treatment and management 
who meets the quality requirements of 
(hhh)(2)(C).’’; and 
(2) by adding at the end the following new sub-
sections: 
‘‘(hhh) LYMPHEDEMA DIAGNOSIS AND TREATMENT 
SERVICES.—(1) The term ‘lymphedema diagnosis and 
treatment services’ means, with respect to an individual 
and consistent with paragraph (3), differential diagnosis 
and treatment of lymphedema (regardless of cause) ac-
cording to the current standard of lymphedema diagnosis 
and treatment described in paragraph (2)(A) by, or under 
the direction of, a health care professional that is a cer-
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tified provider as described in paragraph (2)(B) in an out-
patient setting and that meets the quality standards de-
scribed in paragraph (2)(C), but only if the physician who 
is managing the individual’s lymphedema certifies that 
such services are needed under a comprehensive plan of 
care related to the individual’s diagnosed lymphedema. 
‘‘(2) For purposes of paragraph (1): 
‘‘(A) The current standard of lymphedema di-
agnosis and treatment described in this subpara-
graph is such standard as defined by the American 
Cancer Society and the International Society of 
Lymphology and called ‘complex decongestive ther-
apy’, a multi-modal therapy comprising manual 
lymph drainage, compression therapy, exercise, and 
skin care. Such standard consists of the initial phase 
of treatment which is performed by qualified health 
care professionals on an outpatient basis (Phase 1 
treatment) and the continuing maintenance phase 
(Phase 2 treatment) which is performed in a home 
setting by the patient, patient’s family, or patient’s 
aide after receiving instruction described in para-
graph (5). 
‘‘(B) A qualified provider is a physician or 
lymphedema therapist knowledgeable of the diag-
nosis and current medical standard of treatment of 
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lymphedema, or any other individual or entity des-
ignated by the Secretary, that, in addition to pro-
viding 
lymphedema 
outpatient 
self-management 
training 
services 
(as 
defined 
in 
paragraph 
(3)(C)(iii)), provides other items or services for 
which payment may be made under this title. 
‘‘(C)(i) Subject to clause (ii), the quality stand-
ards described in this subparagraph are quality 
standards established by the Secretary equivalent to 
the 
practice 
standards 
established 
by 
the 
Lymphology Association of North America. 
‘‘(ii) In applying this subsection during the 3- 
year period beginning on the date of the enactment 
of this subsection, a therapist who has completed at 
least 135 hours of lymphedema treatment training 
and is certified by the training school is deemed to 
have met the requirement of clause (i), and may 
practice under a certified provider within a plan of 
care developed by the certified provider; regardless 
of whether the therapist meets the experience stand-
ards established by the Lymphology Association of 
North America. 
‘‘(D) The term ‘lymphedema diagnosis’ means 
the differential diagnosis of the source of the pa-
tient’s edema and the identification of the specific 
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etiology in order to develop the lymphedema treat-
ment plan. Such term shall include diagnostic tools 
such as the lymphoscintigraphic functional test or 
other test the Secretary determines to be efficatious 
to directly observe lymphatic system function may be 
indicated if medical history or tests to rule out other 
causes are not adequate to provide a clear positive 
diagnosis of lymphedema. 
‘‘(3) COVERAGE.—With respect to lymphedema diag-
nosis and treatment services coverage under this part, the 
following shall apply: 
‘‘(A) MANUAL LYMPH DRAINAGE.— 
‘‘(i) Lymphedema diagnosis and treatment 
services coverage under this part shall include 
an initial course of manual lymph drainage as 
part of complete decongestive therapy (Phase 1) 
when medically required by the qualified pro-
vider described in paragraph (2)(B). 
‘‘(ii) The schedule and number of manual 
lymph drainage treatment sessions shall be de-
termined 
by 
the 
treating 
physician 
or 
lymphedema therapist as required by medical 
necessity, and not the limits governing rehabili-
tation therapy described in section 1833(g). 
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‘‘(B) COMPRESSION
BINDING
SYSTEMS, GAR-
MENTS AND DEVICES.— 
‘‘(i) For purposes of this part, the mate-
rials and aids used in lymphedema compression 
therapy— 
‘‘(I) while physically resembling items 
in other benefit categories such as surgical 
dressings, 
durable 
medical 
equipment, 
splints and braces, orthotics and pros-
thetics described in subsections (s)(5), 
(s)(6), and (s)(9), do not serve the same 
medical function as such items in such 
other categories and have significantly dif-
ferent therapeutic characteristics and uses; 
and 
‘‘(II) are specified in subsection (iii) 
as a separate benefit category. 
‘‘(ii) Such coverage shall include any com-
pression garments, binding systems and devices 
described in subsection (iii) deemed by the pa-
tient’s qualified caregiver to be medically nec-
essary as part of the treatment of lymphedema. 
‘‘(iii) Such coverage shall include replace-
ments when required to maintain their medi-
cally required compressive function or to accom-
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modate changes in the patient’s dimensions or 
medical condition. 
‘‘(C) LYMPHEDEMA SELF-MANAGEMENT TRAIN-
ING.— 
‘‘(i) IN GENERAL.— 
‘‘(I) The initial course of treatment 
(phase 1) described in paragraph (2)(A), 
with respect to such services, shall include 
training of the patient and an aide or fam-
ily member as required to perform self- 
treatment in a home setting, including any 
of the following home treatment modalities 
which are determined by the qualified pro-
vider to be medically required and are a 
part of the continuing maintenance phase 
(phase 2) home treatment plan described 
in paragraph (2)(A): 
‘‘(aa) Self-manual lymph drain-
age (simple lymph drainage). 
‘‘(bb) Compression bandaging. 
‘‘(cc) Donning and care of com-
pression garments. 
‘‘(dd) Performance of an appro-
priate decongestive exercise program. 
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‘‘(ee) Use of specialized manually 
adjustable compression devices, don-
ning aids, and other required ancillary 
equipment; and if medically indicated. 
‘‘(ff) Use of sequential gradient 
compression pneumatic pump. 
‘‘(II) As part of such treatment, pa-
tient training shall include instruction on 
periodic self-measurements, skin care, indi-
cations of infection, and the steps to be 
taken if infection occurs. 
‘‘(III) The term ‘lymphedema out-
patient self-management training services’ 
means educational and training services 
furnished to an individual diagnosed with 
lymphedema by a certified provider (as de-
scribed in paragraph (2)(B)) in an out-
patient setting but only if the physician 
who 
is 
managing 
the 
individual’s 
lymphedema condition certifies that such 
services are needed under a comprehensive 
plan of care related to the individual’s 
lymphedema condition. 
‘‘(ii) CONSULTATION WITH ORGANIZATIONS 
IN
ESTABLISHING
PAYMENT
AMOUNTS
FOR 
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SERVICES
PROVIDED
BY
PHYSICIANS.—In es-
tablishing payment amounts under section 1848 
for 
physicians’ 
services 
consisting 
of 
lymphedema outpatient self-management train-
ing services, the Secretary shall consult with 
appropriate organizations, including such orga-
nizations representing individuals or Medicare 
beneficiaries with lymphedema, in determining 
the relative value for such services under sec-
tion 1848(c)(2). 
‘‘(D) MEASUREMENTS TO DEFINE TREATMENT 
EFFICACY.—Periodic measurements shall be made to 
enable evaluation of the efficacy of the treatment 
plan and patient adherence, to modify the treatment 
plan or to determine the need for follow-up courses 
of treatment. 
‘‘(E) FOLLOW-UP TREATMENT.—Such coverage 
shall provide for follow-up treatments whenever 
medically required to periodically validate home tech-
niques, to monitor progress against the written 
treatment plan, and to modify the treatment plan as 
required. 
‘‘(F) DENIAL.—No individual other than a li-
censed physician or certified lymphedema therapist 
competent to evaluate the specific clinical issues in-
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volved in the care requested, may deny or modify re-
quests for authorization of health care services or 
materials described in subsection (iii) pursuant to 
this subsection. 
‘‘(G) PROHIBITION
OF
ADDITIONAL
TREAT-
MENT FEES.—No additional fees or deductibles may 
be assessed, with respect to such treatment, for com-
pliance with this title other than assessed for similar 
medical services. 
‘‘(iii) LYMPHEDEMA
COMPRESSION
TREATMENT 
ITEMS.— 
‘‘(1) DEFINITION.—The term ‘lymphedema 
compression treatment item’ means compression 
therapy materials and supplies used daily in the 
medical treatment of lymphedema upon prescription 
of the treating physician or therapist, including— 
‘‘(A) compression binding systems com-
prising, as medically required, short-stretch and 
medium-stretch compression bandages; cotton, 
synthetic, or foam padding; gauze or elastic fin-
ger and toe bandages; foam pads; and tubular 
bandages; 
‘‘(B) compression garments and compres-
sion 
pads 
for 
compression 
treatment 
of 
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lymphedematous arms, legs, torso, face and 
neck, breast and chest, abdomen, and genitalia; 
‘‘(C) 
manually-adjustable 
compression 
sleeves and padded directional flow sleeves for 
use on upper and lower limbs; 
‘‘(D) orthotic shoes; and 
‘‘(E) donning aids, bandage rollers, and 
other specialized items used with the items de-
scribed in subparagraphs (A) through (D). 
‘‘(2) SPECIAL REQUIREMENT ON LYMPHEDEMA 
PUMPS.—Such term shall include a pneumatic pump 
for the treatment of lymphedema only if the treating 
physician or therapist’s prescription for such pump 
is accompanied by a certificate of medical necessity 
which specifies as a minimum— 
‘‘(A) 
the 
differential 
diagnosis 
of 
lymphedema and any related co-conditions such 
as venous insufficiency, peripheral arterial dis-
ease, lipedema, morbid obesity, myxedema, and 
any other condition which may be significant in 
the selection of a type, specification, and usage 
of the pump; and 
‘‘(B) the physician’s or therapist’s judge-
ment of the type and specifications of the pump 
based on the patient’s medical necessity.’’. 
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(b) PAYMENT.— 
(1) LYMPHEDEMA OUTPATIENT SELF-MANAGE-
MENT
TRAINING
SERVICES
INCLUDED
AS
PHYSI-
CIANS’ SERVICES.—Section 1861(s)(2)(S) of such 
Act (42 U.S.C. 1395x(s)(2)(S)) is amended by in-
serting ‘‘and lymphedema outpatient self-manage-
ment 
training 
services 
under 
subsection 
(hhh)(3)(C)’’ after ‘‘subsection (qq))’’. 
(2) LYMPHEDEMA
COMPRESSION
TREATMENT 
ITEMS.— 
(A) IN
GENERAL.—Section 1833(a) of 
such Act (42 U.S.C. 1395l(a)) is amended— 
(i) in paragraph (8), by striking at 
the end ‘‘and’’; 
(ii) in paragraph (9), by striking at 
the end the period and inserting a semi- 
colon; and 
(iii) by adding at the end the fol-
lowing new paragraph: 
‘‘(10) in the case of lymphedema compression 
treatment items described in section 1861(iii), the 
amount determined under section 1834(n); and’’. 
(B) 
PAYMENT
DETERMINED.—Section 
1834 of such Act (42 U.S.C. 1395m) is amend-
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ed by adding at the end the following new sub-
section: 
‘‘(n) PAYMENT
FOR LYMPHEDEMA COMPRESSION 
TREATMENT ITEMS.— 
‘‘(1) GENERAL RULE FOR PAYMENT.— 
‘‘(A) IN
GENERAL.—With respect to a 
lymphedema compression treatment item de-
scribed in section 1861(iii) for which payment 
is determined under this subsection, subject to 
subparagraph (D), payment shall be made in an 
amount equal to 80 percent of the payment 
basis described in subparagraph (B). 
‘‘(B) 
PAYMENT
BASIS.—The 
payment 
basis described in this subparagraph, with re-
spect to a lymphedema compression treatment 
item described in section 1861(iii), is the actual 
charge for the item. 
‘‘(C) EXCLUSIVE
PAYMENT
RULE
FOR 
HOME
HEALTH
AGENCIES.—This subsection 
shall constitute the exclusive provision of this 
title for payment for lymphedema compression 
treatment items described in section 1861(iii) 
under this part or under part A to a home 
health agency. 
‘‘(D) EXCEPTIONS.— 
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‘‘(i) Subparagraph (B) shall not apply 
to an item furnished by a public home 
health agency (or by another home health 
agency which demonstrates to the satisfac-
tion of the Secretary that a significant por-
tion of its patients are low income) free of 
charge or at nominal charges to the public. 
‘‘(ii) Subparagraph (B) shall not 
apply to items that are furnished as an in-
cident to a physician’s professional service. 
‘‘(2) SPECIAL PAYMENT RULES.— 
‘‘(A) ALLOWABLE ITEMS.—To be eligible 
for payment under this subsection, an item de-
scribed in section 1861(iii) must— 
‘‘(i) be ordered by a qualified physi-
cian or lymphedema therapist for treat-
ment of diagnosed lymphedema; 
‘‘(ii) primarily and customarily be 
used to serve a medical purpose; 
‘‘(iii) generally not be useful to a per-
son in the absence of an illness or injury; 
and 
‘‘(iv) be appropriate for use in the 
home. 
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‘‘(B) ALLOWABLE
QUANTITIES.—In the 
case it is determined by the qualified physician 
or qualified lymphedema therapist involved that 
compression therapy demands daily compression 
as part of lymphedema treatment according to 
section 1861(hhh)(1), then payment may be 
made in accordance with this subsection for the 
following quantities— 
‘‘(i) in the case of compression bind-
ing 
systems 
described 
in 
section 
1861(iii)(1)(A), 2 sets for each affected 
body part; 
‘‘(ii) in the case of compression gar-
ments described in section 1861(iii)(1)(B), 
2 garments for each affected body part; 
‘‘(iii) in the case of compression de-
vices described in section 1861(iii)(1)(C), 1 
each for each affected body part; and 
‘‘(iv) in the case of compression ther-
apy 
aids 
described 
in 
section 
1861(iii)(1)(D), as determined by the 
qualified 
physician 
or 
qualified 
lymphedema therapist. 
‘‘(C) ALLOWABLE USE.—Payment may be 
made under this subsection for a lymphedema 
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compression treatment item described in section 
1861(iii) only if such item— 
‘‘(i) is prescribed by a certified pro-
vider 
as 
defined 
in 
section 
1861(hhh)(2)(B); 
‘‘(ii) is used as part of a lymphedema 
treatment 
plan 
described 
in 
section 
1861(hhh)(1); 
‘‘(iii) is used by a patient who has 
been instructed in lymphedema self-man-
agement 
described 
in 
section 
1861(hhh)(5); and 
‘‘(iv) is used to treat a diagnosed con-
dition of chronic lymphedema. 
‘‘(D) 
COMPRESSION
RANGE.—The 
lymphedema compression treatment items for 
which payment may be made under this section 
must provide a compression no less than 
30mmHg and no greater than 60mmHg. 
‘‘(E) 
QUALIFIED
FITTERS.—The 
lymphedema compression treatment items for 
which payment may be made under this section 
must be measured and fitted by a qualified fit-
ter who is an individual who— 
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‘‘(i) is a qualified lymphedema thera-
pist, as defined in section 1834(o)(2), who 
meets the quality standards of section 
1861(hhh)(2)(C); 
‘‘(ii) in the case of a State that pro-
vides for the licensing of orthotists and 
prosthetists, is licensed in orthotics or 
prosthetics by the State in which the item 
is supplied; 
‘‘(iii) in the case of a State that does 
not provide for the licensing of orthotists 
and prosthetists, is specifically trained and 
educated to provide or manage the provi-
sion of prosthetics and custom-designed or 
-fabricated orthotics, and is certified by the 
American 
Board 
for 
Certification 
in 
Orthotics and Prosthetics, Inc. or by the 
Board for Orthotist/Prosthetist Certifi-
cation, or is credentialed and approved by 
a program that the Secretary determines, 
in consultation with appropriate experts in 
orthotics and prosthetics, has training and 
education standards that are necessary to 
provide such prosthetics and orthotics; or 
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‘‘(iv) is certified by the qualified man-
ufacturer of the item to be qualified to fit 
the particular garment or device. 
‘‘(F) REQUIREMENTS FOR SUPPLIERS OF 
COMPRESSION THERAPY ITEMS.—A supplier of 
the lymphedema compression treatment items 
described in this subsection must meet the re-
quirements of section 1834(j) in order to re-
ceive payment under this subsection. 
‘‘(3) REPLACEMENT OF COMPRESSION THERAPY 
ITEMS.— 
‘‘(A) IN
GENERAL.—Payment shall be 
made under this subsection, with respect to an 
individual, for the replacement of compression 
bindings, compression garments, or compression 
devices if an ordering physician determines that 
the provision of a replacement item, or repair of 
such an item, is necessary because of any of the 
following: 
‘‘(i) A change in the physiological or 
medical condition of the individual. 
‘‘(ii) A loss of required compression of 
the item that is not restorable by washing 
and drying. 
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‘‘(iii) An irreparable change in the 
condition of the device, or in a part of the 
device. 
‘‘(B) LENGTH
OF
REASONABLE
USEFUL 
LIFETIME.—The reasonable useful lifetime of a 
lymphedema compression treatment item de-
scribed in section 1861(iii) shall be as follows, 
except that, if the Secretary determines that, on 
the basis of prior experience in making pay-
ments for such an item under this title, such 
lifetimes are no longer appropriate with respect 
to a particular item, the Secretary shall estab-
lish an alternative reasonable lifetime for such 
item: 
‘‘(i) COMPRESSION BINDING KIT.—In 
the case of compression binding systems 
described in section 1861(iii)(1)(A), the 
greater of 6 months or per manufacturer’s 
warrantee. 
‘‘(ii) COMPRESSION
GARMENTS.—In 
the case of compression garments de-
scribed in section 1861(iii)(1)(B), the 
greater of 4 months or per manufacturer’s 
warrantee. 
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‘‘(iii) COMPRESSION DEVICES.—In the 
case of compression devices described in 
section 1861(iii)(1)(C), the greater of 3 
years or per manufacturer’s warrantee. 
‘‘(iv) AIDS.—In the case of compres-
sion therapy aids described in section 
1861(iii)(1)(D), as required to maintain 
functional usefulness.’’. 
(C) SUPPLIER
REQUIREMENTS.—Section 
1834(j)(5) of such Act (42 U.S.C. 1395m(j)(5)) 
is amended— 
(i) in subparagraph (E), by striking 
at the end ‘‘and’’; 
(ii) in subparagraph (F), by striking 
at the end the period an inserting ‘‘; and’’; 
and 
(iii) by adding at the end the fol-
lowing new subparagraph: 
‘‘(G) lymphedema compression treatment 
items (as described in section 1861(iii)).’’. 
(3) LYMPHEDEMA DIAGNOSIS AND TREATMENT 
SERVICES.— 
(A) IN
GENERAL.—Section 1833(a) of 
such Act, as amended by paragraph (2)(A), is 
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further amended by adding at the end the fol-
lowing new paragraph: 
‘‘(11) with respect to lymphedema diagnosis 
and treatment services (as defined in subsection 
(hhh)(1))— 
‘‘(A) furnished by a qualified physical ther-
apist or qualified occupational therapist, as de-
fined in section 1834(o)(2)(A), the amounts de-
scribed in section 1834(k); or 
‘‘(B) furnished by a lymphedema therapist, 
as defined by 1834(o)(2)(B), under direction of 
a qualified physical therapist or qualified occu-
pational therapist, the amounts described in 
section 1834(o).’’. 
(B) PAYMENT METHOD.—Section 1834 of 
such Act, as amended by paragraph (2)(B), is 
further amended by adding at the end the fol-
lowing new subsection: 
‘‘(o) PAYMENT FOR OUTPATIENT LYMPHEDEMA DI-
AGNOSIS AND TREATMENT SERVICES.— 
‘‘(1) IN
GENERAL.—For purposes of section 
1833(a)(11)(B), in the case of lymphedema diag-
nosis and treatment services described in section 
1861(hhh) for which payment is determined under 
this subsection and that are performed by a quali-
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fied lymphedema therapist (as defined in paragraph 
(2)) under the direction of a qualified physician 
therapist or qualified occupational therapist, the 
payment basis shall be 80 percent of the lesser of— 
‘‘(A) the actual charge for the service; or 
‘‘(B) the applicable fee schedule amount 
(as defined in paragraph (3)) for the services. 
‘‘(2) QUALIFIED THERAPISTS.—For purposes of 
this subsection: 
‘‘(A) IN GENERAL.—The term ‘qualified’, 
with respect to a physical therapist, occupa-
tional therapist, or lymphedema therapist, 
means that the physical therapist, occupational 
therapist, or lymphedema therapist meets the 
quality 
requirements 
described 
in 
section 
1861(hhh)(2)(C). 
‘‘(B) 
LYMPHEDEMA
THERAPIST.—The 
term ‘lymphedema therapist’ means any of the 
following individuals so long as such individual 
is legally authorized to practice by the State in 
which the lymphedema diagnosis and treatment 
service involved is performed and meets the 
quality requirements described in subparagraph 
(A): 
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‘‘(i) A registered nurse, nurse practi-
tioner, family nurse practitioner or clinical 
nurse specialist (as described in section 
1861(aa)(5)). 
‘‘(ii) A doctor of medicine or doctor of 
osteopathy 
(as 
described 
in 
section 
1861(r)(1). 
‘‘(iii) A physician assistant (as de-
scribed in section 1861(aa)(5)). 
‘‘(iv) A chiropractor. 
‘‘(v) A licensed massage therapist. 
‘‘(vi) A licensed home health practi-
tioner. 
‘‘(3) APPLICABLE FEE SCHEDULE AMOUNT.— 
In this subsection, the term ‘applicable fee schedule 
amount’ means, with respect to services furnished in 
a year, the amount determined under the fee sched-
ule established under section 1848 for such services 
furnished during the year or, if there is no such fee 
schedule established for such services, the amount 
determined under the fee schedule established for 
such comparable services as the Secretary specifies. 
‘‘(4) UNIFORM CODING.—For claims for serv-
ices for which the amount of payment is determined 
under this subsection, the claim shall include a code 
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(or codes) under a uniform coding system specified 
by the Secretary that identifies the services fur-
nished. 
‘‘(5) RESTRAINT ON BILLING.—The provisions 
of 
subparagraphs 
(A) 
and 
(B) 
of 
section 
1842(b)(18) shall apply to lymphedema diagnosis 
and treatment services for which payment is made 
under this subsection in the same manner as they 
apply to services provided by a practitioner described 
in section 1842(b)(18)(C), except that in applying 
such subparagraphs the practitioner described shall 
be any practitioner described in paragraph (2)(B).’’. 
(C) EXCLUSION FROM CERTAIN THERAPY 
SERVICES.—Section 1833(g)(4) of such Act (42 
U.S.C. 1395l(g)(4)) is amended by inserting 
‘‘or to expenses incurred with respect to 
lymphedema diagnosis and treatment services 
(as defined in subsection (hhh)(1))’’ before the 
period at the end. 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall apply to items and services furnished on 
or after the date that is 90 days from the date of the 
enactment of this Act. 
Æ 
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