Medicare Clinical Note Requirements for Lymphedema Garments

Abilico has developed an unofficial guide outlining the documentation required to cover compression treatment items as part of the new Lymphedema Treatment Act. This document is designed to facilitate communication and streamline the qualification process for coverage, although it does not guarantee coverage.

Essential Clinical Notes Documentation:

1. Author of Notes:

   • Identify the treating physician or therapist who is completing the notes.

2. Beneficiary’s Information:

   • Include the full name of the beneficiary.

3. Date of Documentation:

   • The notes must be dated within the last 12 months to be valid.

4. Medical Diagnosis:

   • Clearly state the diagnosis relevant to the treatment.

5. Diagnosis Code:

   • Include the specific diagnosis code. Covered codes under the Lymphedema Treatment Act include:

     • I89.0: Lymphedema, not elsewhere classified

     • Q82.0: Hereditary Lymphedema

     • I97.2: Postmastectomy Lymphedema Syndrome

     • I97.89: Other postprocedural complications and disorders of the circulatory system not elsewhere classified

6. Need for Compression Treatment:

   • Document the necessity for the compression treatment item and the affected limb(s), specifying:

     • Off-the-Shelf Items: List the required item.

     • Custom Items: Detailed descriptions of the custom garment and all custom options must be included (e.g., 20-30 mmHg, flat-knit, knee-high with a silicone top band, closed toe, t-heel, etc.) Additionally, the reasons why a custom item is necessary over an off-the-shelf item must be documented, such as:

       • Disproportionate limb circumference.

       • Special needs due to skin folds or contours requiring a specific knitting pattern.

       • Intolerance to the fabric of standard garments.

     • Bandaging: Document if the patient is in Phase 1 (acute or decongestive therapy) or Phase 2 (maintenance phase) of lymphedema therapy.

     • Accessories: List any required accessories.

7. Length of Need or Duration:

   • Document how long the patient will need to use the garment and how often it should be replaced ex. (3 units every 6 months for 99 years)