Does 29584 require prior authorization?

No, 29584 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 29584?

Medicare facility rate: $13.36. Non-facility rate: $74.48. Work RVU: 0.34.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

0.34

Facility

$13.36

Non-Facility

$74.48

Medical record must document the diagnosis of lymphedema and explicitly exclude other causes of tissue edema.
Documentation must record recent changes in condition and prior unsuccessful therapies used to justify skilled decongestive treatment.
Records must show services were provided by a qualified clinician and that the services met accepted standards of medical practice and were specific and effective for the patient’s condition.
Medical record must clearly indicate the patient’s condition before, during, and after the therapy episode and demonstrate significant, sustainable benefit measured against the start of treatment.

Diagnosis of lymphedema documented in the medical record (not tissue edema from other etiologies such as chronic venous insufficiency, congestive heart failure, or acute infection).
Recent change in the patient’s condition documented that justifies initiation of decongestive therapy.
Prior unsuccessful conservative therapies (e.g., elevation, prior bandaging, diuresis) are documented and reported to justify the need for skilled services.
Services are provided by a qualified clinician (physician, non-physician practitioner, qualified therapist, or appropriately supervised therapist assistant).
Medically necessary hands-on Manual Lymphatic Drainage (MLD) is covered and billed using CPT 97140.
A brief period (for example, three or fewer sessions) of patient/caregiver instruction in compression bandaging home management is covered when medically necessary and documented, billed using CPT 97535.

AETNA-CPB-0009 — Orthopedic Casts, Braces and Splints

A55710 — Lymphedema Decongestive Treatment

A57067 — Billing and Coding: Outpatient Physical and Occupational Therapy Services

L34049 — Outpatient Physical and Occupational Therapy Services

A52959 — Billing and Coding: Lymphedema Decongestive Treatment

Ask Verity about documentation requirements, denial risks, or coverage in your state.