Medicare Prescription Requirements for Lymphedema Garments

In light of the Lymphedema Treatment Act and the inclusion of compression treatment items in Medicare coverage, Abilico provides this updated, unofficial guide. This document lists the necessary documentation required for Medicare coverage of lymphedema garments. Please note that this list is subject to updates as new information becomes available and does not guarantee coverage. It is intended to aid in the process for qualifying patients.

Prescription Requirements:

1. Date of Prescription:

   • The prescription must be dated within the last 11 months and remain valid when the service or product is delivered.

2. Beneficiary Information:

   • Include the full name of the beneficiary.

3. Description of Required Items:

   • Specify the affected side(s): Left, Right, or Bilateral.

   • For knit garments, include the required compression level and garment length (e.g., calf, thigh, panty), and note if custom-made garments are necessary.

   • For Velcro wraps, specify the coverage area (e.g., calf, knee, thigh).

   • For bandaging supplies, list the coverage area (e.g., lower leg, full leg, arm).

   • List any necessary accessories to ensure coverage.

4. Quantity:

   • State the number of each item required.

5. Physician Information:

   • Provide the physician’s name, contact information, and NPI number.

6. Physician Signature:

   • The prescription must include the physician's signature, which can be hand-signed or electronic. Stamped signatures are not acceptable.

*Since the prescription is not part of the official medical record, everything included in the Rx should also be referenced in the clinical notes.