For lymphedema therapists and prescribing providers
Custom garments cost more than ready-to-wear, so insurance plans look closely at the paperwork. Clear, complete documentation is the fastest way to get a custom garment approved and into the patient's hands.
The order
A complete written order usually includes:
Patient name and date of birth
Order date
Diagnosis and ICD-10 code, including laterality (right, left or both)
Item description: custom, garment type (for example, thigh-high stocking, arm sleeve, gauntlet), body area and side
Compression level in mmHg
Daytime or nighttime use
Quantity
Prescribing provider's name, NPI, signature and date
Missing laterality, compression level or the word "custom" are some of the most common reasons we have to send an order back.
Why custom instead of ready-to-wear
The chart notes should explain why a standard garment won't work. Common reasons include:
Limb size or shape outside standard size ranges
Irregular contours, such as skin folds, lobules, a deep ankle crease or a large difference between segments
Fibrosis or tissue changes that need a firmer, shaped fabric
Ready-to-wear garments tried and failed: they rolled, dug in, slid down or didn't control swelling
Fragile skin or a history of wounds where a poorly fitting garment could cause breakdown
Lipedema or lipo-lymphedema needing flat-knit fabric
Be specific. "Patient requires custom garment" alone is usually not enough. Note what was tried and what happened, or which measurements fall outside standard sizing.
Supporting notes
A recent visit with the prescribing provider addressing the condition
Therapy notes showing the treatment course, ideally that the reduction phase is complete and the limb has stabilized
Limb measurements taken at the end of reduction, on the manufacturer's form
Symptoms and functional impact, such as heaviness, pain, recurrent cellulitis, wounds or trouble with daily activities
The plan for how the garment will be used, such as daily daytime wear with nighttime compression
Nighttime garments
If ordering a nighttime garment, document why it's needed, for example swelling that returns overnight, moderate to severe lymphedema, or nighttime bandaging during treatment that the patient can't continue at home.
Replacements and size changes
For a replacement before the usual schedule, document the reason, such as a change in limb size, damage or loss, with new measurements if the size changed.
Quick checklist
[ ] Complete order with laterality, mmHg, "custom" and quantity
[ ] Provider signature, NPI and date
[ ] Diagnosis code
[ ] Notes explaining why custom is needed
[ ] Recent provider visit
[ ] Therapy notes and end-of-reduction measurements
[ ] Nighttime garment justification, if ordered
How Midwest Compression can help
We review every custom order before it goes to the manufacturer and will tell you exactly what's missing. Orders can be sent through Parachute Health or by fax. Email customersupport@midwestcompression.com or call 800-883-1549.
Need forms? Find every measurement form, sizing guide and order form on our Measurement & Sizing Forms page, and manufacturer charts on our Size Charts page.
This article is general guidance. Documentation requirements vary by insurance plan.
