---
kind: "section"
citation: "42 C.F.R. § 414.1650"
title: "42"
number: "414.1650"
heading: "Payment basis for lymphedema compression treatment items."
url: "https://uscodex.org/cfr/42/414.1650"
---

# §414.1650. Payment basis for lymphedema compression treatment items.

- (a) **General payment rule.** For items furnished on or after January 1, 2024, Medicare pays for lymphedema compression treatment items on the basis of 80 percent of the lesser of—
  - (1) The actual charge for the item; or
  - (2) **The payment amount for the item, as determined in accordance with paragraph (b) of this section.**
- (b) **Payment amounts.** The payment amounts for covered lymphedema compression treatment items paid for under this subpart are established based on one of the following:
  - (1) If payment amounts are available from Medicaid state plans, then 120 percent of the average of the Medicaid payment amounts.
  - (2) If payment amounts are not available from Medicaid state plans, then 100 percent of the average of average internet retail prices and payment amounts from TRICARE (Department of Defense).
  - (3) If payment amounts are not available from Medicaid state plans or TRICARE, then 100 percent of average internet retail prices.
- (c) **Updates to payment amounts.** The payment amounts for covered lymphedema compression treatment items established in accordance with [paragraph (b)](#b) of this section are increased on an annual basis beginning on January 1 of the year subsequent to the year in which the payment amounts are initially established based on the percent change in the Consumer Price Index for all Urban Consumers (CPI-U) for the 12-month period ending with June of the previous year.

## Notes

### Source

Source: 88 FR 77876, Nov. 13, 2023, unless otherwise noted.

### Authority

Authority: 42 U.S.C. 1302, 1395hh, and 1395rr(b)(l).

### Source

Source: 55 FR 23441, June 8, 1990, unless otherwise noted.