A6562 Compression Stocking HCPCS Reimbursement | OpenPayer

Summary & Overview

HCPCS A6562: Gradient Compression Stocking, Waist Length, Custom, 18-30 mmHg

HCPCS Level II code A6562 denotes a custom waist-length gradient compression stocking delivering 18-30 mmHg of pressure, billed per garment. These custom compression stockings are used to manage chronic venous insufficiency, lymphedema, and other venous or lymphatic disorders where graduated compression and waist-length coverage are clinically indicated. Nationally, custom compression garments matter because they involve durable medical equipment (DME) policies, medical necessity determinations, and potential coverage variability across major payers.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication outlines how coverage criteria, documentation requirements, and billing practice for custom compression stockings can differ across these payers and highlights areas where prior authorization or detailed fitting documentation is commonly required.

Readers will learn practical benchmarks and policy context relevant to A6562, including the clinical scenarios that typically justify a custom waist-length stocking, common sites of service for provision and fitting, and typical payer considerations. The report provides an overview of reimbursement considerations, documentation expectations, and points of variance among national payers. Data not available in the input will be noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareA6562HCPCS Level IIcompression stockingsdurable medical equipmentcustom garmentsvenous insufficiencylymphedemaoutpatient care

Billing Code Overview

HCPCS Level II code A6562 describes a gradient compression stocking, waist length, 18-30 mmHg, custom, each. The service represents a custom-fitted medical compression garment designed to provide graduated compression from the ankle upward to the waist, with a compression range of 18-30 mmHg.

Service type: Durable Medical Equipment (custom compression garment)

Typical site of service: Outpatient clinic, durable medical equipment supplier, or home setting for fitting and delivery

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A typical patient is an adult with chronic venous insufficiency, varicose veins with edema, post-thrombotic syndrome, or lymphedema requiring custom waist-length gradient compression stockings with 18–30 mmHg at the ankle. The patient is evaluated in an outpatient vascular medicine clinic or a wound care center. The clinician documents the indication, limb measurements for custom fabrication, and medical necessity for gradient compression (for example persistent venous edema, venous stasis dermatitis, recurrent superficial thrombophlebitis, or wound healing adjunct). A certified fitter or orthotic provider obtains waist, hip, thigh, calf and ankle circumferences and orders a custom garment. The supplier fabricates and dispenses one stocking per side as ordered; follow-up includes assessment of fit, skin integrity, and clinical response at 2–8 weeks. Typical sites of service are outpatient clinic, durable medical equipment (DME) supplier location, or home health visit for patients with mobility limitations.

Coding Specifications

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

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HCPCS-A7507-TRACHEOSTOMA-HME-FILTER-HOLDER-INTEGRATED-FILTER

HCPCS A7507: Tracheostoma HME Filter Holder with Integrated Filter

HCPCS-A5512-DIABETIC-MOLDED-MULTIPLE-DENSITY-INSERT-PREFABRICATED

HCPCS A5512: Prefabricated Molded Multiple-Density Diabetic Foot Insert

HCPCS-A7524-TRACHEOSTOMA-STENT-BUTTON

HCPCS A7524: Tracheostoma Stent/Stud/Button

HCPCS-A4248-CHLORHEXIDINE-ANTISEPTIC-1ML

HCPCS Level II A4248: Chlorhexidine Antiseptic, 1 ml

HCPCS-A6407-PACKING-STRIPS-STERILE-WOUND-CARE

HCPCS Level II A6407: Sterile Non-Impregnated Packing Strips, Wound Care

HCPCS-A4306-DISPOSABLE-LOW-FLOW-DRUG-DELIVERY-SYSTEM

HCPCS Level II A4306: Disposable Drug Delivery System, <50 ml/hr

HCPCS-A4736-TOPICAL-ANESTHETIC-DIALYSIS-PER-GRAM

HCPCS A4736: Topical Anesthetic for Dialysis, Per Gram

HCPCS-A5102-BEDSIDE-DRAINAGE-BOTTLE

HCPCS A5102: Bedside Drainage Bottle, Rigid or Expandable

HCPCS-A4620-VARIABLE-CONCENTRATION-MASK

HCPCS A4620: Variable Concentration Mask

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Taxonomy Code	Specialty	Notes
`261QM0800X`	Vascular Medicine Physician	Ordering evaluation and medical necessity documentation
`261QP2600X`	Physical Medicine & Rehabilitation Physician	Management of lymphedema and functional assessment
`261QM1800X`	Wound Care Specialist	Assessment for venous stasis ulcers and need for compression
`3336P0800X`	Orthotist/Prosthetist (DME supplier)	Measurements, fabrication, and dispensing of custom stockings
`363L00000X`	Home Health Agency Provider	Home-based assessment and fitting when patient is homebound

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I83.90`	Varicose veins of lower extremities with unspecified severity, unspecified lower extremity	Varicose veins often cause venous hypertension and edema that benefit from graded compression
`I87.2`	Venous insufficiency (chronic) (peripheral)	Primary indication for gradient compression stockings to reduce edema and improve venous return
`I89.0`	Lymphedema, not elsewhere classified	Custom compression stockings are a mainstay in lymphedema management when off-the-shelf garments are inadequate
`I80.9`	Phlebitis and thrombophlebitis of unspecified site	Post-thrombotic syndrome or residual phlebitis can require compression therapy to manage symptoms
`L97.311`	Non-pressure chronic ulcer of right lower leg limited to breakdown of skin	Compression is an adjunctive therapy for venous stasis ulcers to support healing
`L97.312`	Non-pressure chronic ulcer of left lower leg limited to breakdown of skin	Same clinical relevance for left-sided ulcer care requiring compression
`R22.42`	Localized swelling, lower limb	Objective finding supporting medical necessity for compression garments
`Z48.00`	Encounter for change or removal of surgical dressing	Included as an associated care code when dressing changes and compression are coordinated in wound clinics

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	Common visit code used for the clinic evaluation documenting indication and ordering the custom stocking
`29580`	Application, non-vascular compression device (eg, stockings) (this code may vary by payer)	Represents application or fitting services when billed separately by a supplier or clinician when permitted by payer policy
`29540`	Unna boot application (for comparison of a lower-extremity compression adjunct)	Performed in wound care settings when compression therapy is part of ulcer management; may be billed in conjunction with stocking provision
`97012`	Traction, mechanical (or other physical therapy modalities as comparator)	Physical therapy codes commonly billed in the same episode of care for lymphedema management alongside compression
`97530`	Therapeutic activities, direct patient contact (eg, therapeutic exercises)	Rehabilitative services for patients with mobility limitations related to chronic venous disease, often part of the same care plan

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