What qualifications do I need to obtain garments through Medicare?
You must have Clinical/Appointment Notes from the treating Lymphedema therapist or treating Physician and a Certificate of Medical Necessity (CMN) / Prescription from the treating Physician.
What do the notes need to say?
Notes must state the reason for the encounter, relevant history, physical exam findings, test results, date of service, and stage of Lymphedema (0-3), International Society of Lymphology (ISL). In addition, notes should list the garments being ordered (HCPC codes) and side(s) effected, and if applicable, why an alternative garment would not be effective in self-management. Absolute Medical can provide an example of the clinical note for you to provide to your Dr or therapist on an upcoming appointment.
What needs to be on the CMN/ Prescription?
One of the following Diagnosis ICD 10 – A codes: Lymphedema, not elsewhere classified (I89.0), Hereditary Lymphedema (Q82.0), Postmastectomy Lymphedema Syndrome (I97.2), or Other postprocedural complications and disorders of the circulatory system, not elsewhere classified (I97.89) The CMN (prescription) must have your Dr signature and list the item codes and quantities, Absolute Medical will send this to your doctor to be completed.
How are measurements determined?
Measurements can be determined directly by your therapist at a physical therapy appointment, or your therapist may request Absolute Medical to measure you at an in-person or virtual appointment. Measurements will need to be provided by your therapist or an Absolute Medical team member before ordering.
How long will it take to get my garments?
Custom garments take approximately 2-3 weeks from the time of purchase, where ready to wear garments take about 1-2 weeks from the time of purchase depending on manufacturer availability. If there are any delays, we will contact you via email or phone to provide updated order information.
When will my garments be purchased?
Garments are purchased once all necessary documentation to bill your insurance is obtained or retail payment is on file. We strongly encourage patients to reach out to their Doctors Office to speed up the documentation process.
What happens if my garments don’t fit?
Once products and services have been accepted by me and my benefits are assigned to my provider, there are no returns, refunds, or claims retractions allowed. Any fitting issues with custom items must be reported to my provider within 30 calendar days from the date of service when I received and accepted them. Many of our custom manufacturers allow a remake for fit issues. Ready-to-wear garments can be exchanged for a different size of the same item within 14 calendar days from the date of service. Please contact us with any fit issues as soon as possible.
What if I need to order more garments?
You can email us at Customerservice@absolutemedical.com or call 312-233-2207
