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    v1.0.31
    OpenPayerBilling CodesMedical And Surgical SuppliesHCPCS hcpcs-a6523-gradient-compression-arm-padded-nighttime-custom
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    HCPCS Level II A6523: Gradient Compression Garment, Arm, Padded, Nighttime

    HCPCS Level II code A6523 describes a custom, padded gradient compression garment for the arm intended for nighttime use; this custom durable medical equipment item is supplied as a single arm garment and is used for compression therapy in outpatient, home, or durable medical equipment settings to manage lymphedema, edema, or post-procedural swelling.

    For related coverage guidance, see recent payer policy updates: Diabetic Supplies, Radiofrequency Ablation for Thyroid Nodules, Continuous Glucose Monitoring and Insulin Delivery for Managing Diabetes (for Idaho Only).

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    Table of contents

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    Clinical & Coding Specifications

    Clinical Context

    A patient with a history of lymphedema of the upper extremity following breast cancer treatment is fitted for a custom, padded, nighttime gradient compression arm garment (A6523). The typical workflow begins in an outpatient lymphedema clinic, physical medicine and rehabilitation office, or durable medical equipment (DME) supplier after referral from the patient’s oncologist, surgeon, or primary care provider. The patient receives a clinical assessment documenting limb measurements, degree of edema, skin integrity, and functional limitations. A certified lymphedema therapist or trained clinician performs serial circumferential measurements and documents objective improvement goals. A prescription/order authorizing a custom, padded, nighttime gradient compression garment is written by an authorized prescriber and includes laterality (RT or LT), size, and clinical justification (e.g., persistent stage II lymphedema, nocturnal fluid redistribution). The DME supplier takes custom molding or measurements and fabricates the garment to provide graduated compression intended for overnight use to maintain limb reduction achieved by daytime therapy. The patient returns for fitting, education on donning/doffing, skin care, and documentation of wear tolerance. Follow-up visits assess fit, skin changes, and therapy response; replacement or adjustments are ordered as clinically indicated. Typical sites of service include outpatient clinics, DME supplier locations, and the patient’s home for delivery and fitting.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    97162Physical therapy evaluation, moderate complexityPerformed before ordering a custom garment to document functional deficits and therapy needs
    97530Therapeutic activities, direct (one-on-one)Active lymphedema therapy sessions that may precede garment ordering to reduce limb volume
    97140Manual therapy techniques (e.g., manual lymphatic drainage)Commonly performed to reduce edema prior to measurement and fitting of a nighttime garment
    99401Preventive medicine counseling, individualPatient education on skin care and risk reduction provided during fitting visits
    99070Supplies and materials (e.g., custom padding) used in the provision of DMEBilling for non-implantable supply items related to custom padding or fitting

    Related Modifiers

    5 rows

    ModifierDescriptionWhen to Use
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    59Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
    80CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    332B00000X
    207P00000X
    207L00000X
    208000000X
    261QB0400X
    207YS0012X
    364ST0500X
    207YX0602X

    Related ICD-10-CM Codes

    24 rows

    ICD-10-CM CodeDescription
    G56.01Carpal tunnel syndrome, right upper limb
    G57.51Tarsal tunnel syndrome, right lower limb
    I80.219Phlebitis and thrombophlebitis of unspecified iliac vein
    I83.009Varicose veins of unspecified lower extremity with ulcer of unspecified site
    I87.2Venous insufficiency (chronic) (peripheral)
    I89.0Lymphedema, not elsewhere classified
    I97.2Postmastectomy lymphedema syndrome
    M25.511Pain in right shoulder
    M25.512Pain in left shoulder
    M54.6Pain in thoracic spine

    Showing 1–10 of 24

    Related Payer Policy Updates

    Specialty: Endocrinology1 / 3

    10 rows

    PolicyPayerEffective Date
    Diabetic SuppliesCigna2026-10-15
    Radiofrequency Ablation for Thyroid NodulesCigna2026-10-15
    Continuous Glucose Monitoring and Insulin Delivery for Managing Diabetes (for Idaho Only)UnitedHealthcare2026-10-01
    Continuous Glucose Monitoring and Insulin Delivery for Managing Diabetes (for Indiana Only)UnitedHealthcare2026-10-01
    Tzield (teplizumab-mzwv) CoverageUnitedHealthcare2026-10-01
    Medical Necessity Guidelines Insulin PumpsMass General Brigham Health Plan2026-10-01
    Medical Necessity Guidelines: Continuous Glucose MonitorsMass General Brigham Health Plan2026-10-01
    Continuous Glucose MonitoringAmbetter Nevada2026-10-01
    Salivary Hormone TestingOscar Health2026-10-01
    Bone Turnover Markers TestingOscar Health2026-10-01

    Related Codes

    HCPCS-A4206-STERILE-SYRINGE-1CC-NEEDLE

    HCPCS A4206: Syringe with Needle, 1 cc or Less, Sterile

    HCPCS-A4207-STERILE-2CC-SYRINGE-WITH-NEEDLE

    HCPCS Level II A4207: Syringe with Needle, Sterile 2 cc

    HCPCS-A4208-STERILE-3CC-SYRINGE-WITH-NEEDLE

    HCPCS Level II A4208: Syringe with Needle, Sterile 3 cc

    HCPCS-A4209-STERILE-SYRINGE-WITH-NEEDLE-5CC-OR-GREATER

    HCPCS Level II A4209: Syringe with Needle, Sterile 5 cc or Greater

    HCPCS-A4210-NEEDLE-FREE-INJECTION-DEVICE

    HCPCS Level II A4210: Needle-free Injection Device, Each

    HCPCS-A4211-SUPPLIES-SELF-ADMINISTERED-INJECTIONS

    HCPCS Level II A4211: Supplies for Self-Administered Injections

    HCPCS-A4212-NON-CORING-NEEDLE-STYLET-CATHETER-ACCESS-SUPPLY

    HCPCS Level II A4212: Non-coring Needle or Stylet with/without Catheter

    HCPCS-A4213-STERILE-SYRINGE-20CC-OR-GREATER

    HCPCS Level II A4213: Syringe, Sterile, 20 cc or Greater, Each

    HCPCS-A4215-STERILE-NEEDLE-SINGLE-EACH

    HCPCS Level II A4215: Needle, Sterile, Any Size

    HCPCS-A4216-STERILE-DILUENT-FLUSH-10ML

    HCPCS Level II A4216: Sterile Diluent/Flush, 10 ml

    Showing 1–10 of 633

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    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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