---
kind: "section"
citation: "42 C.F.R. § 414.1670"
title: "42"
number: "414.1670"
heading: "Procedures for making benefit category determinations and payment determinations for new lymphedema compression treatment items."
url: "https://uscodex.org/cfr/42/414.1670"
---

# §414.1670. Procedures for making benefit category determinations and payment determinations for new lymphedema compression treatment items.


The procedures for determining whether new items and services addressed in a request for a HCPCS Level II code(s) or by other means meet the definition of items and services paid for in accordance with this subpart are as follows:

- (a) At the start of a HCPCS coding cycle, CMS performs an analysis to determine if the item is statutorily excluded from coverage under Medicare under [section 1862](/cfr/42/1862.md) of the Act.
  - (1) If not excluded by statute, then CMS determines whether the item is a lymphedema compression treatment item as defined under [section 1861(mmm)](/cfr/42/1861.md?p=mmm) of the Act.
  - (2) If excluded by statute, the analysis is concluded.
- (b) If a preliminary determination is made that the item is a lymphedema compression treatment item, CMS makes a preliminary payment determination for the item or service.
- (c) CMS posts preliminary benefit category determinations and payment determinations on CMS.gov approximately 2 weeks prior to a public meeting.
- (d) After consideration of public consultation provided at a public meeting on preliminary benefit category determinations and payment determinations for items, CMS establishes the benefit category determinations and payment determinations for items through program instructions.

## 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.