42 CFR § 414.1670 - Procedures for making benefit category determinations and payment determinations for new lymphedema compression treatment items.
---
identifier: "/us/cfr/t42/s414.1670"
source: "ecfr"
legal_status: "authoritative_unofficial"
title: "42 CFR § 414.1670 - Procedures for making benefit category determinations and payment determinations for new lymphedema compression treatment items."
title_number: 42
title_name: "Public Health"
section_number: "414.1670"
section_name: "Procedures for making benefit category determinations and payment determinations for new lymphedema compression treatment items."
chapter_name: "CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES"
subchapter_number: "B"
subchapter_name: "MEDICARE PROGRAM"
part_number: "414"
part_name: "PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES"
positive_law: false
currency: "2026-04-05"
last_updated: "2026-04-05"
format_version: "1.1.0"
generator: "[email protected]"
authority: "42 U.S.C. 1302, 1395hh, and 1395rr(b)(l)."
regulatory_source: "55 FR 23441, June 8, 1990, unless otherwise noted."
cfr_part: "414"
---
# 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 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) 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.