A6555 Gradient Compression Stocking Reimbursement

HCPCS Level II code A6555 denotes a custom below-knee gradient compression stocking providing 40 mmHg or greater compression per garment. These high-compression, custom-fitted stockings are clinically significant for managing severe venous insufficiency, lymphedema, post-thrombotic syndrome, and other conditions requiring strong graduated compression. Nationally, coverage and utilization of custom high-compression garments influence DME spending and access to specialized fittings.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of what A6555 represents, typical sites of service and service line context, and which payers commonly manage coverage for custom high-compression below-knee stockings. The publication outlines benchmarks for billing and utilization where available, summarizes relevant payer policy approaches and prior authorization trends, and provides clinical context for when custom 40 mmHg stockings are used versus off-the-shelf options.

This summary is designed to inform billing staff, DME suppliers, and policy analysts about the code's clinical purpose, payer landscape, and the types of documentation and fittings typically associated with claims for HCPCS Level II code A6555.

Billing Code Overview

HCPCS Level II code A6555 represents a gradient compression stocking, below knee, 40 mmHg or greater, custom, each. This item is a custom-fitted medical compression garment intended to provide therapeutic graduated compression of 40 mmHg or greater for the lower leg.

Service Type: Durable Medical Equipment (custom compression garment)

Typical Site of Service: Outpatient clinic, durable medical equipment supplier, or home setting where custom fitting and measurement occur

Data not available in the input.

Clinical Context

A 67-year-old patient with chronic venous insufficiency and persistent lower-extremity edema presents to a vascular clinic. The clinician evaluates the patient, documents symptomatic leg swelling, skin changes consistent with venous stasis, and prior failure of over-the-counter compression stockings. A prescription is written for a custom, below-knee gradient compression stocking with at least 40 mmHg compression to manage edema and improve venous return. The typical workflow includes a vascular or wound care consultation, measurement of the lower extremity by a certified fitter or clinician to capture limb circumference at multiple levels, ordering the custom garment, and follow-up fitting to confirm fit and patient tolerance. The stocking is billed per limb as A6555 (each). Typical suppliers coordinate with the clinician for documentation, obtain prior authorization if required by the payer, fabricate the custom stocking, and arrange delivery with patient education on wear schedule, care, and return for replacement or re-measurement as clinically indicated.

Coding Specifications

Modifier	Description	When to Use
`LT`	Left side	When the custom below-knee stocking is for the left lower extremity
`RT`

Taxonomy Code	Specialty	Notes
`251B00000X`	Vascular Surgery	Common diagnosing and prescribing specialty for venous disease and compression therapy
`207ZP2900X`	Wound Care/Cardiology overlap (Wound Care specialist)	Wound care clinicians frequently prescribe compression for venous stasis ulcers and edema
`163W00000X`	Physical Medicine & Rehabilitation (PM&R)	PM&R clinicians manage lymphedema and chronic edema and may prescribe custom compression garments
`207RI0000X`	Internal Medicine	Primary care and internists often initiate therapy and coordinate durable medical equipment orders
`261QP2300X`	Orthotist/Prosthetist	Orthotists or certified fitters often perform measurements and fittings for custom compression garments

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I83.10`	Varicose veins of left lower extremity with ulcer, unspecified	Varicose veins with ulceration indicate need for compression to manage venous hypertension and promote healing
`I83.90`	Varicose veins of unspecified lower extremity without ulcer or inflammation	Varicose veins with symptomatic reflux often require gradient compression for symptom control
`I87.2`	Venous insufficiency (chronic) (peripheral)	Chronic venous insufficiency is a primary indication for graduated compression garments of 40 mmHg or greater
`I89.0`	Lymphedema, not elsewhere classified	Lymphedema management frequently uses custom compression stockings to reduce limb volume and maintain reduction post-decongestive therapy
`L97.901`	Non-pressure chronic ulcer of unspecified part of lower leg, not elsewhere classified, unspecified severity	Chronic lower-leg ulcers related to venous disease frequently require high-compression custom stockings as part of therapy

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99213`	Office or other outpatient visit for the evaluation and management of an established patient, typically 15 minutes	Used for the clinical evaluation and documentation that supports medical necessity for the custom compression stocking order
`97760`	Orthotic(s) fitting and training, initial encounter, lower extremity	Performed by orthotists or trained clinicians to fit and instruct the patient on use of the custom stocking
`29581`	Application of multi-layer compression system; leg (below knee)	May be used in wound care settings for compression therapy; related to clinical management of venous ulceration where custom stockings are part of ongoing care
`97010`	Application of a modality to one or more areas; hot or cold packs	Used adjunctively in therapy visits managing edema and venous symptoms prior to or concurrently with provision of compression
`99070`	Supplies and materials provided by the physician over and above those usually included with the service	Used when additional non-standard supplies or custom measurement materials are required during fitting

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Summary & Overview

HCPCS A6555: Below-Knee Gradient Compression Stocking, 40 mmHg, Custom