MedicaidBilling CodesMedium impact
[Indiana] Lymphedema Compression Treatment Items Claims Editing Enhancements
CareSource·IN · Physical Therapy, Wound Care, General Surgery +1 more·Provider Bulletin
Effective date
May 4, 2026
We identified it
May 9, 2026
Summary
CareSource is implementing enhanced claims editing for lymphedema compression treatment items (HCPCS codes A6520-A6610) effective May 4, 2026. Billing teams must ensure appropriate lymphedema diagnosis codes are used and apply right side (RT) or left side (LT) modifiers for bilateral claims, as the payer will now enforce stricter validation on these claims.
Action Required
By May 4, 2026: Billing team must implement the following updates: (1) Ensure all claims for lymphedema compression treatment codes (A6520-A6530, A6533-A6541, A6549, A6552-A6589, A6593-A6610) include appropriate lymphedema diagnosis codes; (2) Update billing system to require and automatically apply RT (right side) or LT (left side) modifiers for all lymphedema compression claims to indicate treatment laterality; (3) Review current billing templates and encounter forms to prompt providers for correct diagnosis coding and laterality documentation; (4) Train billing staff on the new requirements. Failure to include proper diagnosis codes and laterality modifiers will result in claim denials from CareSource. Contact CareSource Health Partner Services at 1-833-230-2101 (Marketplace) or 1-844-607-2831 (Medicaid) with questions.