I97.2: Postmastectomy lymphedema syndrome
I97.2, postmastectomy lymphedema syndrome, is listed as a covered diagnosis in 4 Medicare billing and coding articles that apply to 17 HCPCS Level II codes, including L8035 (Custom breast prosthesis, post mastectomy, molded to…), L8002 (Breast prosthesis, mastectomy bra, with integrated breast…), L8001 (Breast prosthesis, mastectomy bra, with integrated breast…). 6 of these codes have a 2026 DMEPOS fee schedule amount; L8035 pays $4,403.11 to $5,283.69 depending on the state. The articles come from 2 Medicare contractors. A listed diagnosis supports medical necessity only; coverage still depends on the LCD's criteria and on documentation in the medical record.
HCPCS Level II codes with I97.2 as a covered diagnosis
| Code | Description | Medicare coverage | DMEPOS fee 2026 (state range) | Articles listing it |
|---|---|---|---|---|
| L8035 | Custom breast prosthesis, post mastectomy, molded to patient model, any type | Special coverage instructions apply | $4,403.11–$5,283.69 | 1 |
| L8002 | Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, bilateral, any size, any type | Special coverage instructions apply | $198.27–$218.12 | 1 |
| L8001 | Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, unilateral, any size, any type | Special coverage instructions apply | $150.77–$165.83 | 1 |
| L8015 | External breast prosthesis garment, with mastectomy form, post mastectomy | Special coverage instructions apply | $72.05–$86.41 | 1 |
| L8000 | Breast prosthesis, mastectomy bra, without integrated breast prosthesis form, any size, any type | Special coverage instructions apply | $44.70–$78.16 | 1 |
| A4280 | Adhesive skin support attachment for use with external breast prosthesis, each | Carrier judgment | $7.38–$8.13 | 1 |
| G0283 | Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care | Carrier judgment | — | 3 |
| G0281 | Electrical stimulation, (unattended), to one or more areas, for chronic stage iii and stage iv pressure ulcers, arterial ulcers, diabetic ulcers, and venous stasis ulcers not demonstrating measurable signs of healing after 30 days of conventional care, as part of a therapy plan of care | Carrier judgment | — | 2 |
| G0329 | Electromagnetic therapy, to one or more areas for chronic stage iii and stage iv pressure ulcers, arterial ulcers, diabetic ulcers and venous stasis ulcers not demonstrating measurable signs of healing after 30 days of conventional care as part of a therapy plan of care | Carrier judgment | — | 2 |
| G0152 | Services performed by a qualified occupational therapist in the home health or hospice setting, each 15 minutes | Carrier judgment | — | 1 |
| G0158 | Services performed by a qualified occupational therapist assistant in the home health or hospice setting, each 15 minutes | Carrier judgment | — | 1 |
| G0160 | Services performed by a qualified occupational therapist, in the home health setting, in the establishment or delivery of a safe and effective occupational therapy maintenance program, each 15 minutes | Carrier judgment | — | 1 |
| G2169 | Services performed by an occupational therapist assistant in the home health setting in the delivery of a safe and effective occupational therapy maintenance program, each 15 minutes | Carrier judgment | — | 1 |
| G2010 | Remote evaluation of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related e/m service provided within the previous 7 days nor leading to an e/m service or procedure within the next 24 hours or soonest available appointment | Carrier judgment | — | 1 |
| G2250 | Remote assessment of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related service provided within the previous 7 days nor leading to a service or procedure within the next 24 hours or soonest available appointment | Carrier judgment | — | 1 |
| G2251 | Brief communication technology-based service, e.g. virtual check-in, by a qualified health care professional who cannot report evaluation and management services, provided to an established patient, not originating from a related service provided within the previous 7 days nor leading to a service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of clinical discussion | Carrier judgment | — | 1 |
| G0151 | Services performed by a qualified physical therapist in the home health or hospice setting, each 15 minutes | Carrier judgment | — | 1 |
Medicare policy articles listing I97.2
- A52478: External Breast Prostheses - Policy Article (CGS Administrators, LLC (DME MAC) Noridian Healthcare Solutions, LLC (DME MAC); 6 Level II codes). LCD with the same title: L33317
- A53057: Billing and Coding: Home Health Occupational Therapy (Palmetto GBA (HHH MAC); 5 Level II codes). LCD with the same title: L34560
- A53064: Billing and Coding: Outpatient Occupational Therapy (Palmetto GBA (MAC - Part A); 3 Level II codes). LCD with the same title: L34427
- A57311: Billing and Coding: Physical Therapy - Home Health (CGS Administrators, LLC (HHH MAC); 7 Level II codes). LCD with the same title: L33942
A diagnosis listed as covered in a billing and coding article supports medical necessity for the article's codes; it does not guarantee payment. Coverage depends on the LCD's criteria, the contractor's jurisdiction and documentation in the medical record.
Other I97 diagnoses (Intraoperative and postprocedural complications and disorders of circulatory system, not elsewhere classified)
- I97.0 — Postcardiotomy syndrome
- I97.110 — Postprocedural cardiac insufficiency following cardiac surgery
- I97.111 — Postprocedural cardiac insufficiency following other surgery
- I97.120 — Postprocedural cardiac arrest following cardiac surgery
- I97.121 — Postprocedural cardiac arrest following other surgery
- I97.130 — Postprocedural heart failure following cardiac surgery
- I97.131 — Postprocedural heart failure following other surgery
- I97.190 — Other postprocedural cardiac functional disturbances following…
- I97.191 — Other postprocedural cardiac functional disturbances following other…
- I97.710 — Intraoperative cardiac arrest during cardiac surgery
- I97.711 — Intraoperative cardiac arrest during other surgery
- I97.790 — Other intraoperative cardiac functional disturbances during cardiac…
- I97.791 — Other intraoperative cardiac functional disturbances during other…
- I97.88 — Other intraoperative complications of the circulatory system, not…
- I97.89 — Other postprocedural complications and disorders of the circulatory…
Frequently asked questions
Does Medicare cover I97.2 (Postmastectomy lymphedema syndrome)?
Medicare covers items and services, not diagnoses. 4 Medicare billing and coding articles list I97.2 as a covered diagnosis for 17 HCPCS Level II codes: the diagnosis can support medical necessity for those codes, but payment still depends on the LCD's coverage criteria and the medical record.
Which HCPCS codes can be billed with ICD-10 I97.2?
The Level II codes from the policies most specific to this diagnosis are L8035 (Custom breast prosthesis, post mastectomy, molded to…, 1 article); L8002 (Breast prosthesis, mastectomy bra, with integrated breast…, 1 article); L8001 (Breast prosthesis, mastectomy bra, with integrated breast…, 1 article); L8015 (External breast prosthesis garment, with mastectomy form…, 1 article); L8000 (Breast prosthesis, mastectomy bra, without integrated…, 1 article). Code choice depends on the item supplied; check each code's descriptor.
What does Medicare pay for equipment billed with I97.2?
Under the 2026 DMEPOS fee schedule (non-rural state fees): L8035 $4,403.11 to $5,283.69; L8002 $198.27 to $218.12; L8001 $150.77 to $165.83; L8015 $72.05 to $86.41. Medicare pays 80% of the allowed amount after the Part B deductible.
Which Medicare policy articles list I97.2?
A52478 (External Breast Prostheses - Policy Article); A53057 (Billing and Coding: Home Health Occupational Therapy); A53064 (Billing and Coding: Outpatient Occupational Therapy), and 1 more article.
What is ICD-10-CM code I97.2?
I97.2 is the ICD-10-CM code for postmastectomy lymphedema syndrome, in category I97 (Intraoperative and postprocedural complications and disorders of circulatory system, not elsewhere classified), chapter 9: Diseases of the circulatory system.
Next steps
- Run a reimbursement report for a device billed under L8035
- Watch L8035 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for L8035
Sources: CMS Medicare Coverage Database billing and coding articles (covered ICD-10 code lists and HCPCS links); ICD-10-CM FY2026; CMS HCPCS Level II release October 2026; CMS DMEPOS fee schedule 2026 (non-rural state fees). Not billing or legal advice.
Chapter 9: Diseases of the circulatory system · All diagnoses · HCPCS lookup