A6560 Gradient Compression Stocking Reimbursement

HCPCS Level II code A6560 denotes a custom, full-length (chap-style) gradient compression stocking providing 30–40 mmHg of pressure. These garments are clinically relevant for management of chronic venous disease, significant edema, and lymphedema and are commonly prescribed when off-the-shelf options are inadequate. Nationally, custom compression supplies like A6560 are significant because they involve higher unit costs, medical necessity determinations, and varied coverage rules across payers.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of how A6560 is defined and used in clinical practice, common sites of service where the item is supplied, and typical billing considerations. The publication also summarizes benchmarks and policy-relevant points such as prior authorization patterns, documentation expectations for custom-fitted compression garments, and coding contexts where A6560 is selected over standard dimensions.

This summary prepares clinicians, billing staff, and policy analysts to understand the code's clinical role, payer landscape, and the primary operational factors that affect coverage and claims handling for custom gradient compression stockings.

Billing Code Overview

HCPCS Level II code A6560 describes a gradient compression stocking, full length/chap style, 30-40 mmHg, custom, each. The item is a custom-fitted, full-length stocking designed to provide graduated compression of 30-40 millimeters of mercury, typically used to manage chronic venous insufficiency, severe edema, lymphedema, or related circulatory conditions.

Service type: Custom fitted durable medical equipment / compression garment

Typical site of service: Outpatient clinic, durable medical equipment supplier, home health setting

Clinical Context

A 68-year-old patient with chronic venous insufficiency and symptomatic varicosities is prescribed a custom full-length gradient compression stocking, 30–40 mmHg, A6560. The patient is measured in the clinic by a certified fitter following a vascular surgery or wound care consultation. The clinical workflow includes: initial evaluation by a vascular specialist or wound care clinician, documentation of diagnosis and medical necessity (for example, chronic venous insufficiency with edema or status post venous ulcer), order for a custom stocking due to limb shape or prior failed standard sizes, measurement and fitting appointment, delivery of the custom A6560 stocking, and follow-up to assess fit, skin tolerance, and therapeutic response. Typical sites of service are outpatient specialty clinics (vascular surgery, wound care, or prosthetics/orthotics shop), durable medical equipment (DME) supplier locations, and occasionally in an inpatient setting when ordered during hospital care prior to discharge.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when unusual time, effort, or technical difficulty in custom measurement or fabrication significantly exceeds typical requirements for `A6560`.

Taxonomy Code	Specialty	Notes
`207K00000X`	Vascular Surgery	Vascular surgeons evaluate venous disease and prescribe custom compression when indicated.
`261QM0800X`	Physical Medicine & Rehabilitation	PM&R specialists manage lymphedema and chronic edema requiring custom compression.
`3336C0002X`	Wound Care/Cardiology overlap (wound care specialist)	Wound care clinicians assess venous ulcers and coordinate custom compression therapy.
`333600000X`	Orthotics & Prosthetics	Certified fitters/orthotists perform measurements and fabricate or order custom `A6560` stockings.
`363L00000X`	Vascular Medicine	Non-surgical vascular specialists who manage chronic venous disease and prescribe compression therapy.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I83.10`	Varicose veins of right lower extremity with ulcer, unspecified	Varicose veins with ulceration commonly require gradient compression to reduce venous hypertension and assist healing.
`I83.90`	Varicose veins of lower extremity, unspecified	Varicose veins causing edema or pain are an indication for graduated compression stockings such as `A6560`.
`I87.2`	Venous insufficiency (chronic)	Chronic venous insufficiency is a primary indication for prescription of custom gradient compression stockings.
`I89.0`	Lymphedema, not elsewhere classified	Lymphedema often requires custom compression garments when standard sizes do not fit or when higher compression is needed.
`L97.409`	Non-pressure chronic ulcer of unspecified part of right lower leg with unspecified severity	Chronic leg ulcers from venous disease are managed with compression therapy to promote healing and reduce edema.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`97140`	Manual therapy techniques (e.g., mobilization/manipulation), each 15 minutes	Performed by physical therapists in conjunction with lymphedema management; may precede or accompany prescription of `A6560` for edema control.
`97112`	Neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, and/or proprioception	Used in rehabilitation plans addressing mobility limitations related to chronic venous disease; may be part of a treatment plan that includes custom compression.
`29540`	Strapping, ankle and/or foot	Short-term adjunctive measures applied by clinicians before definitive custom compression fitting; minor procedural code sometimes used in clinic.
`99213`	Office or other outpatient visit for the evaluation and management of an established patient, low to moderate complexity	Typical E/M visit during which the need for custom `A6560` is documented, measurements are ordered, and medical necessity is recorded.
`99406`	Smoking and tobacco use cessation counseling visit, intermediate, greater than 3 minutes up to 10 minutes	Counseling relevant when tobacco use worsens peripheral vascular disease; may be provided during the visit ordering compression therapy.

OpenPayer

Summary & Overview

HCPCS A6560: Gradient Compression Stocking, Full Length Custom 30-40 mmHg