The short version: for Medicare lymphedema compression garments, wraps and bandaging, the lymphedema diagnosis has to be documented by the patient's treating practitioner (MD, DO, NP, PA or CNS) in that practitioner's own medical record. A therapist's evaluation or progress note, even one the physician has countersigned, does not satisfy this on its own. Your notes are still valuable, but they can't be the only place the diagnosis appears.
What changed
On March 26, 2026, the four Medicare DME contractors published a revision of the joint article Lymphedema Compression Treatment Items – Correct Coding and Billing. The revision added a Documentation Requirements section, which the contractors describe as a clarification. Under it:
The treating practitioner (MD, DO, NP, PA or CNS) must document the lymphedema diagnosis in the beneficiary's medical record.
Documentation from a licensed clinical medical practitioner, such as a physical, occupational or lymphedema therapist, does not meet this requirement, even if the prescriber countersigns it.
The medical record can still include therapist records, along with hospital, nursing home and home health records. These support the order; they just can't stand in for the treating practitioner's diagnosis.
For custom garments, the record must also explain why a custom item is needed instead of off-the-shelf.
Quantity and replacement have to be supported in the record: up to three daytime garments or wraps per body area every six months, and two nighttime garments per body area every 24 months.
Covered diagnosis codes remain I89.0, I97.2, I97.89 and Q82.0.
What this means for your referrals
A common reason we have to go back to an office is a referral where the diagnosis appears only in the therapy evaluation. To avoid that delay:
Make sure the treating provider's own note names lymphedema and the affected area, for example "lymphedema of the right lower extremity (I89.0)." The diagnosis should also appear on the prescription.
Send your evaluation and measurements too. They support the garment choice, the custom rationale and the quantity, even though they can't establish the diagnosis.
If the provider's note doesn't mention lymphedema, ask the office for a signed addendum from the treating provider documenting the diagnosis.
For custom garments, make sure the record explains why ready-to-wear won't work. See Documenting a Custom Garment for sample language.
Compression pumps (E0651 and E0652)
Pump coverage still follows National Coverage Determination 280.6, which has not changed. Two things to keep in mind:
Prior authorization is required for E0651 and E0652 nationwide for dates of service on or after April 13, 2026.
The DME contractors' pump checklists expect therapist (LCMP) records used for the four-week conservative trial to be signed by the treating practitioner, showing their agreement. The treating practitioner's own note should still state the diagnosis, the trial and the outcome.
See Getting a Pump Approved: E0651 vs. E0652 for the full pump checklist. Pump referrals come to us by fax at 800-886-4201 or through our secure referral portal.
Quick checklist
Lymphedema diagnosis in the treating provider's note (not only in therapy notes)
Diagnosis on the prescription
Note signed and dated by the treating provider
Therapy evaluation and measurements attached
Custom rationale, if the garment is custom
Quantity that fits the replacement limits
We'll help you get it right
We review every referral before we submit it and tell you exactly what's missing. If you're unsure whether a provider note will meet the requirement, fax it to us at 800-886-4201 or call 800-883-1549 and we'll look at it with you.
Sources: Lymphedema Compression Treatment Items – Correct Coding and Billing – Revised (Joint DME MAC, March 26, 2026); Pneumatic Compression Devices (Noridian JD DME); Pneumatic Compression Devices Prior Authorization (CGS).
This summary is for education and is current as of November 2026. Always check the current Medicare contractor guidance; requirements can change.
