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. BLU-
MENAUER, 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 pro-
gram related to the treatment of lymphedema. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
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SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Lymphedema Diag-
nosis and Treatment Cost-Saving Act of 2011’’. 
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 (EE), by striking 
‘‘and’’ at the end; 
(B) in subparagraph (FF), by adding 
‘‘and’’ at the end; and 
(C) by adding at the end the following new 
subparagraph: 
‘‘(GG)(i) lymphedema diagnosis services 
(as 
defined 
in 
subsection 
(iii)(1)) 
and 
lymphedema treatment services (as described in 
subsection (iii)(2)); and 
‘‘(ii) lymphedema compression treatment 
items (as defined in subsection (jjj)).’’; and 
(2) by adding at the end the following new sub-
sections: 
‘‘(iii) LYMPHEDEMA DIAGNOSIS
AND TREATMENT 
SERVICES.—(1) LYMPHEDEMA DIAGNOSIS SERVICES.— 
The term ‘lymphedema diagnosis services’ means, with re-
spect to an individual, the differential diagnosis of the 
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source of the individual’s edema and the identification of 
the specific etiology and functional lymphatic deficiency, 
in which such diagnosis— 
‘‘(A) is provided by a provider, as defined in 
paragraph (3), for the purpose of developing a 
lymphedema treatment plan; and 
‘‘(B) may utilize any diagnostic tools the pro-
vider determines to be reasonable and necessary. 
‘‘(2) LYMPHEDEMA TREATMENT SERVICES.—The 
term ‘lymphedema treatment services’ means, with respect 
to an individual, services for the treatment of lymphedema 
(regardless of cause)— 
‘‘(A) that are— 
‘‘(i) provided in an inpatient or outpatient 
setting; 
‘‘(ii) provided by a provider, as defined in 
paragraph (3), within the established scope of 
practice of such provider; and 
‘‘(iii) medically necessary, in accordance 
with the current standard of lymphedema treat-
ment, including complete decongestive therapy, 
which is a multi-modal therapy comprising of 
manual lymph drainage, compression therapy 
utilizing multilayer bandage systems, compres-
sion garments and devices, exercise, skin care, 
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patient education, and any other lymphedema 
treatment modalities determined by the Sec-
retary to be safe and effective; and 
‘‘(B) which shall— 
‘‘(i) include as medically necessary with re-
spect to the individual— 
‘‘(I) an initial evaluation and course 
of clinical treatment, including initial base-
line measurements and subsequent meas-
urements to assess treatment efficacy and 
progress; 
‘‘(II) follow-up courses of clinical 
treatment; 
‘‘(III) in the case that such individual 
has cancer, clinical measurements, includ-
ing initial pre-operative baseline measure-
ments and periodic subsequent measure-
ments 
to 
diagnose 
the 
presence 
of 
lymphedema; and 
‘‘(IV) any other treatment modality 
approved by the Secretary; and 
‘‘(ii) be provided in accordance with such 
schedule, duration, and number of treatments 
as determined medically necessary. 
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‘‘(3) PROVIDER DEFINED.—For purposes of this sub-
section and subsection (jjj), the term ‘provider’ means any 
licensed medical or health care provider whose State li-
censing 
board 
recognizes 
lymphedema 
diagnosis, 
lymphedema treatment, or both to fall within the scope 
of practice of such medical or health care provider. 
‘‘(jjj) LYMPHEDEMA
COMPRESSION
TREATMENT 
ITEMS.—The term ‘lymphedema compression treatment 
items’ means, with respect to an individual, compression 
garments, devices, bandaging systems, components, and 
supplies that are primarily and customarily used in the 
medical treatment of lymphedema of the arms, hands, 
legs, feet, torso, face and neck, breast and chest, abdomen, 
and genitalia, as prescribed by a provider, as defined in 
subsection (iii)(3). Such term includes— 
‘‘(1) multilayer compression bandaging systems, 
including short-stretch and medium-stretch compres-
sion bandages; cotton, synthetic, or foam padding; 
gauze or elastic finger and toe bandages; foam pads; 
directional flow padding; and tubular bandages; 
‘‘(2) custom or standard fit gradient compres-
sion garments; 
‘‘(3) non-elastic and low-elastic compression 
garments, manually adjustable or fitted padded di-
rectional flow garments (with or without elastic or 
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non-elastic compression jackets) and compression 
wraps and directional flow pads; 
‘‘(4) aids and ancillary equipment consisting of 
donning aids, bandage rollers, shoes to fit over com-
pression items, and other specialized items used with 
the items described in paragraphs (1) through (3); 
‘‘(5) pneumatic appliances connected to and 
used in conjunction with pneumatic sequential com-
pression controllers; 
‘‘(6) any other compression garments, ban-
daging systems, devices, and aids determined by the 
Secretary to be effective in the prevention or treat-
ment of lymphedema; and 
‘‘(7) replacements of any items under this sub-
section in accordance with section 1834(p)(3).’’. 
(b) PAYMENT.— 
(1) 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 
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(iii) by adding at the end the fol-
lowing new paragraph: 
‘‘(10) in the case of lymphedema compression 
treatment items described in section 1861(jjj), the 
amount determined under section 1834(p); and’’. 
(B) 
PAYMENT
DETERMINED.—Section 
1834 of such Act (42 U.S.C. 1395m) is amend-
ed by adding at the end the following new sub-
section: 
‘‘(p) PAYMENT
FOR LYMPHEDEMA COMPRESSION 
TREATMENT ITEMS.— 
‘‘(1) GENERAL RULE FOR PAYMENT.— 
‘‘(A) IN
GENERAL.—With respect to a 
lymphedema compression treatment item as de-
fined in section 1861(jjj)) 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(jjj), is the actual 
charge for the item. 
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‘‘(C) EXCLUSIVE
PAYMENT
RULE
FOR 
HOME
HEALTH
AGENCIES.—Notwithstanding 
any other provision of this title, this subsection 
shall constitute the exclusive provision of this 
title for payment for lymphedema compression 
treatment items described in section 1861(jjj) 
under this part or under part A to a home 
health agency or for such items that are fur-
nished as an incident to a physician’s profes-
sional service. 
‘‘(2) ALLOWABLE QUANTITIES.—In the case it 
is determined by a provider, as defined in section 
1861(iii)(3), that lymphedema compression treat-
ment items are required as part of lymphedema 
treatment services under section 1861(iii)(2), then 
payment may be made under this title in accordance 
with this subsection for such items in the quantity 
which is customary, reasonable, and medically nec-
essary. 
‘‘(3) REPLACEMENT
OF
LYMPHEDEMA
COM-
PRESSION TREATMENT ITEMS.— 
‘‘(A) IN
GENERAL.—Payment shall be 
made under this subsection, with respect to an 
individual, 
for 
the 
replacement 
of 
a 
lymphedema compression treatment item if the 
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period of the reasonable and useful lifetime of 
the item (as described in subparagraph (B)) 
has expired or a provider, as defined in section 
1861(iii)(3), determines that a replacement, or 
repair, of such item, is medically necessary. 
‘‘(B) REASONABLE
AND
USEFUL
LIFE-
TIME.—For purposes of subparagraph (A), the 
period of the reasonable and useful lifetime of 
a lymphedema compression treatment item is as 
follows: 
‘‘(i) In the case of any item described 
in section 1861(jjj)(1), 1 year. 
‘‘(ii) In the case of any item described 
in section 1861(jjj)(2), 6 months. 
‘‘(iii) In the case of any item de-
scribed in section 1861(jjj)(3), 2 years. 
‘‘(iv) In the case of any item described 
in section 1861(jjj)(4), 1 year. 
‘‘(v) In the case of any item described 
in section 1861(jjj)(5), 5 years. 
‘‘(vi) In the case of any item described 
in section 1861(jjj)(6), such period as de-
termined by the Secretary, in consultation 
with appropriate health organizations, at 
the time the Secretary determines such 
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item to be effective in the prevention or 
treatment of lymphedema.’’. 
(C) APPLICATION OF SUPPLIER REQUIRE-
MENTS.—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 and inserting ‘‘; 
and’’; and 
(iii) by adding at the end the fol-
lowing new subparagraph: 
‘‘(G) lymphedema compression treatment 
items (as defined in section 1861(jjj)).’’. 
(2) LYMPHEDEMA DIAGNOSIS AND TREATMENT 
SERVICES.— 
(A) IN
GENERAL.—Section 1833(a) of 
such Act, as amended by paragraph (1)(A), is 
further amended by adding at the end the fol-
lowing new paragraph: 
‘‘(11)(A) in the case of lymphedema diagnosis 
services (as defined in section 1861(iii)(1)) furnished 
by a provider (as defined in section 1861(iii)(3)) the 
amount described in section 1834(q); and 
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