For lymphedema therapists and prescribing providers
Ready-to-wear (standard) garments need less justification than custom garments, but the paperwork still has to be complete. Missing details are the most common reason an order is delayed or a claim is denied.
New Medicare rule: the diagnosis must be in the provider's notes
In March 2026, the Medicare DME contractors added documentation requirements for lymphedema compression items. To support coverage, the diagnosis of lymphedema must be documented by the treating practitioner (MD, DO, NP, PA or CNS) in the patient's medical record.
What this means in practice:
A lymphedema diagnosis that appears only in a therapist's evaluation or a CLT's notes is not enough, even if the provider countersigns it.
The prescribing provider's own note should state the lymphedema diagnosis and the affected area.
The diagnosis should use a qualifying code, such as I89.0 (lymphedema), I97.2 (postmastectomy lymphedema), I97.89 (other postprocedural circulatory complications) or Q82.0 (hereditary lymphedema).
The record should also show the item is being used to treat lymphedema, and support the quantity ordered.
Other insurance plans may follow similar rules, so we recommend this for every patient.
The order
A complete written order usually includes:
Patient name and date of birth (or Medicare ID)
Order date
Description of the item, such as the garment type and body area
Side: right, left or both
Compression level in mmHg
Quantity
Prescribing provider's name, NPI and signature
Progress notes: product details
To match the order to the exact product and avoid delays, the therapist's progress notes should list:
Manufacturer, such as Juzo, Sigvaris, Medi, Jobst or L&R
Model or product line
Quantity, for each body area
Color
It also helps to include size, style details (open or closed toe, top band) and the compression level, so the notes and the order match.
Supporting notes
The provider's note with the lymphedema diagnosis (see above)
Therapy notes showing the treatment plan and that compression is part of ongoing care
Limb measurements used to choose the size
For replacements: the reason, such as normal wear, a change in limb size, or loss or damage
Quick checklist
[ ] Lymphedema diagnosis in the MD, DO, NP, PA or CNS note
[ ] Qualifying diagnosis code
[ ] Complete order with side, mmHg and quantity
[ ] Provider signature, NPI and date
[ ] Progress notes with manufacturer, model, quantity and color
[ ] Measurements
How Midwest Compression can help
We review every order and will let you know right away if anything is 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 and change over time.
