Summary & Overview
HCPCS A4490: Surgical Stockings Above Knee, Each
HCPCS Level II code A4490 denotes an above-knee surgical stocking sold as a single item. Nationally, this code is used to bill for a common post-operative and perioperative medical supply intended to provide compression and edema control for the lower extremity. Its proper use matters for device coverage, site-of-service billing, and supply cost management across hospitals, surgical centers, and outpatient clinics.
Key payers commonly involved in coverage decisions for this supply include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The summary addresses payer inclusion and how coverage varies by benefit designs and medical necessity criteria.
Readers will find a concise review of the code’s clinical context, the typical settings where the item is supplied, and the types of documentation and billing line items associated with durable medical supply billing. The publication also outlines benchmarking and policy considerations relevant to coverage and reimbursement for above-knee surgical stockings, and highlights areas where payers may require additional documentation or prior authorization. Data not available in the input is noted where applicable.
Billing Code Overview
HCPCS Level II code A4490 describes surgical stockings above knee length, each. This code represents a durable medical supply item used to provide compression and support for the lower extremity in surgical and post-operative settings.
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Service type: Medical supply — compression garment
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Typical site of service: Hospital inpatient, hospital outpatient, surgical center, clinic, or other ambulatory care settings where post-operative or perioperative compression stockings are applied
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult postoperative orthopedic patient or a medical patient with chronic venous insufficiency who requires compression therapy. For example, a 68-year-old patient undergoes total knee arthroplasty and, during inpatient recovery, the surgeon prescribes above-knee surgical compression stockings to reduce postoperative deep vein thrombosis risk and manage limb edema. The clinical workflow: the ordering provider documents the medical necessity and size in the medical record, a durable medical equipment or supply coordinator verifies payer coverage and obtains authorization if required, the hospital or clinic supplies A4490 to the patient (each stocking), and the item is billed to the patient’s insurer using the HCPCS code with any applicable modifier. Nursing documents fit, patient education, and daily checks for skin integrity; supply replacement or outpatient home delivery is arranged as clinically indicated.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
NU | New equipment | When the stocking is newly provided to the patient for initial use |
RR | Rental (clinical) | When the stocking is supplied under a rental arrangement per payer policy |
QX | Modifier for ordering/servicing DMEPOS supplier | When an accredited orthotics/prosthetics supplier performs fitting under split-billing rules |
QY | Modifier for ordering/servicing DMEPOS supplier | When supplier is the documentation supplier under certain payer requirements |
52 | Reduced services | When a partial or abbreviated supply is furnished compared with standard |
53 | Discontinued procedure | When stocking supply is planned but discontinued before completion |
59 | Distinct procedural service | When billing must indicate a distinct supply event separate from other services (Note: use only if clinically appropriate) |
76 | Repeat procedure by same provider | When replacement stocking is provided during the same episode by the same provider |
77 | Repeat procedure by another provider | When replacement stocking is provided by a different provider in same timeframe |
22 | Increased procedural services | When exceptional circumstances required a higher level of service to fit or size the stocking |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
207L00000X | Orthopedic Surgery | Orthopedic surgeons commonly order postoperative compression for joint surgery |
207RA0000X | Physical Medicine & Rehabilitation | PM&R specialists manage edema and venous insufficiency requiring compression |
332B00000X | Vascular Surgery | Vascular surgeons treat venous disease and prescribe therapeutic stockings |
334S00000X | General Surgery | General surgeons may order stockings for postoperative thromboprophylaxis |
3336C0002X | Nursing/Clinical Supply Coordinator | Clinical supply managers and wound care nurses handle sizing and dispensing |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
I80.2 | Phlebitis and thrombophlebitis of other deep vessels of lower extremities | Indicates DVT or deep vein inflammation where compression stockings are used for prophylaxis or management |
I83.90 | Varicose veins of lower extremities with unspecified complications | Varicosities causing edema where above-knee compression stockings may be prescribed |
I87.2 | Venous insufficiency (chronic) (peripheral) | Chronic venous insufficiency commonly treated with compression stockings to reduce edema and venous stasis |
Z79.01 | Long term (current) use of anticoagulants | Patients on anticoagulation after surgery often concurrently receive compression stockings for VTE prevention |
Z96.641 | Presence of right artificial knee joint | Postoperative status after knee arthroplasty where compression stockings are part of postoperative care |
Z96.642 | Presence of left artificial knee joint | Same clinical relevance for left-sided knee arthroplasty |
M25.561 | Pain in right knee | Symptom prompting postoperative or conservative management including compression |
M25.562 | Pain in left knee | Same relevance for left-sided symptoms |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
29580 | Application of multi-component compression system, lower extremity | Used for advanced compression therapy fitting; may be performed prior to or instead of single stocking use |
29581 | Application of multi-component compression system; each additional limb | When bilateral limbs require application or additional components |
93970 | Duplex scan of extremity arteries or veins; unilateral or limited study | Vascular imaging to evaluate DVT risk or venous insufficiency prior to prescribing compression |
20550 | Injection(s); single tendon sheath, trigger point, or ganglion cyst | Occasionally performed alongside treatment plans for postoperative pain management (adjunct to compression therapy) |
99213 | Office or other outpatient visit for evaluation and management, established patient | Typical visit code when a clinician evaluates the patient and documents need for A4490 |