​Provider Reference Guide for Compression Garment Ordering

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• Key Terminology: "Unit" vs "Pair" 

When ordering compression garments, it's important to clearly indicate quantity to ensure accurate dispensing and billing. Please note the difference between "unit" and "pair."

 

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• 1 Unit= 1 single garment (e.g., 1 sock, 1 stocking, 1 sleeve, or 1 wrap)

• 1 Pair= 2 units 

 

For example, an order of 6 pairs, bilateral, indicates 12 total units (6 right and 6 left). 

 

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​Required Documentation in the Patient's Chart Notes

 

​Please include: 

1. Active Diagnosis

Must be one of the ICD-10 codes listed on the Standard Written Order Form.

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e.g., "187.2 Venous Insufficiency, 183.813 Varicose veins of bitaleral LE with pain."

2. Type of Garment Recommended 
e.g., "Patient requires below-knee compression stockings" or "Upper extremity compression sleeve and gauntlet." 

3. Compression Strength 
e.g., 20-30 mmHg, 30-40 mmHg, or 40-50 mmHg 

4. Instructions for Wear/ Length of Need

• What side of body to wear it on (e.g., Right, Left, or Bilateral) 
• When to wear (e.g., "Daily wear during waking hours") 
• How long to wear (e.g., "Indefinitely for lifelong management") 

5. Clinical Justification 
e.g., "To control swelling and edema related to chronic venous insufficiency."

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Insurance Companies Currently Accepted and Allowables

 

Reviewed and updated 06/01/2025​​

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NYSHIP (The Empire Plan) 

• Based on medical necessity, may cover up to 48 units or 24 pairs per year

• Allows 12 units per affected area as a 3-month supply

• All vascular, venous, and lymphatic ICD-10 codes are covered

• 100% covered with no co-insurance or deductible

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Medicare 

• Covered for patients with lymphedema diagnoses only, unless they have NYSHIP as a secondary insurance

• Allows 3 units (stockings, wraps, sleeves, gauntlets, or gloves) per affected limb every 6 months

• Allows 2 nighttime garments per affected limb every two years

• Pays 80%

  • Remaining 20% co-insurance may be paid by supplemental insurance plan or by patient​

• ​See Medicare Lymphedema Provider Reference Guide for more details or specific prescribing and documentation​

• Learn more with our Medicare Lymphedema Treatment Act FAQs

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Anthem BCBS and Blue Cross Blue Shield Federal 

• Plans vary, but most have partial or full coverage 

• Some plans may require prior authorization (our specialists will handle submitting this)

• All vascular, venous, and lymphatic ICD-10 codes are covered

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United HealthCare (All Plans)

• Plans vary, but most have partial or full coverage 

• Some plans may require prior authorization (our specialists will handle submitting this)

• All vascular, venous, and lymphatic ICD-10 codes are covered

 

Emblem Health (GHI Only)

• Based on medical necessity

• Covered 100% after the meets meets a $100 DME deductible

• No prior authorization needed

• All vascular, venous, and lymphatic ICD-10 codes are covered