Summary & Overview
HCPCS A6563: Gradient Compression Stocking, Waist Length, 30-40 mmHg, Custom
HCPCS Level II code A6563 represents a custom, waist-length gradient compression stocking delivering 30-40 mmHg of graduated pressure. These custom compression garments are clinically important for managing chronic venous insufficiency, lymphedema, and other conditions requiring sustained graduated compression. Nationally, the code matters because it designates custom-fitted durable medical equipment (DME) that often carries higher unit costs and specific documentation requirements compared with off-the-shelf alternatives.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical uses and expected sites of service, plus coverage and billing benchmarks where available. The publication outlines typical documentation elements, common modifiers for billing practice, and payer policy themes that influence authorization and reimbursement for custom compression garments.
This report provides clinicians, billing staff, and policy analysts with practical context on when A6563 is used, what to expect in payer interactions, and the administrative considerations associated with custom compression stockings. Data not available in the input is noted where applicable.
Billing Code Overview
HCPCS Level II code A6563 describes a gradient compression stocking, waist length, 30-40 mmHg, custom, each. This item is a custom-fitted, waist-length compression garment designed to provide 30-40 millimeters of mercury pressure in a graduated fashion from the distal extremity toward the body.
Service type: custom durable medical equipment (compression garment)
Typical site of service: durable medical equipment supplier, outpatient clinic, or home-delivered DME service
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with symptomatic chronic venous insufficiency or post-thrombotic syndrome who requires waist-length, custom gradient compression stockings at a compression level of 30–40 mmHg. The patient is evaluated in an outpatient vascular clinic or wound care center by a vascular medicine specialist, wound care nurse, or prosthetics/orthotics clinician. Clinical workflow: the clinician documents indication (e.g., chronic venous insufficiency, venous stasis ulcers, lymphedema, post-thrombotic syndrome), performs an extremity vascular exam and, when indicated, obtains duplex ultrasonography to assess venous reflux or obstruction. A custom measurement session is scheduled to obtain waist, hip, thigh, calf, and ankle circumferences and lengths; an order for A6563 is written specifying waist-length, 30–40 mmHg, custom fabrication, quantity one per leg as appropriate. The custom stockings are fabricated by a certified supplier, a fitting appointment verifies fit and comfort, and documentation of measurements, medical necessity, supplier invoice, and patient education is included in the medical record. Typical sites of service: outpatient clinic, wound care center, durable medical equipment supplier site, or patient's home for home health fittings.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
LT | Left side | When the custom stocking is furnished for the left leg only |
RT | Right side | When the custom stocking is furnished for the right leg only |
NU | New equipment | When the stocking is newly provided rather than a replacement |
RR | Rental | When the supplier bills as a rental item (rare for custom stockings) |
QK | Medical courier pick-up and drop-off | When separate courier services for the device delivery/pickup are billed by the supplier |
QX | Modifier certifying practitioner is a naturopathic/other qualified nonphysician | When the ordering practitioner is an eligible nonphysician practitioner as allowed by payer policy (use only if permitted) |
QY | Medical direction of two, three, or four qualified persons | When applicable to supplier billing models that require medical direction reporting (payer-dependent) |
78 | Unplanned return to operating/procedure room by same physician following initial procedure for related procedure during postoperative period | Rarely applicable; used only if a surgical procedure complications require related device replacement intra‑postoperative period |
22 | Increased procedural services | When documentation supports substantially greater work or complexity for custom measurement/fitting beyond typical service |
52 | Reduced services | When fewer services are provided than described by usual supply/fitting (payer-specific applicability) |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
207RG0100X | Vascular Medicine | Clinicians who diagnose and manage venous disease and order compression garments |
251B00000X | Wound Care | Wound care specialists who commonly prescribe compression for venous ulcers |
261QM0800X | Prosthetics/Orthotics | Clinicians and suppliers involved in custom measurement and fabrication |
207L00000X | Vascular Surgery | Surgeons who may prescribe post-operative compression garments |
207L00000X | Physical Medicine & Rehabilitation | Rehabilitation specialists treating lymphedema and chronic venous insufficiency |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
I83.013 | Varicose veins of left lower extremity with ulcer of ankle | Varicose veins with ulceration often require compression therapy including waist-length stockings for venous return support |
I83.111 | Varicose veins of right lower extremity with ulcer of calf | Compression stockings reduce venous hypertension and aid ulcer healing and symptom control |
I87.2 | Venous insufficiency (chronic) (peripheral) | Primary indication for graduated compression stockings to manage edema and pain |
I80.221 | Phlebitis and thrombophlebitis of right lower extremity deep vessels | Post-thrombotic syndrome following DVT often requires 30–40 mmHg compression garments |
I89.0 | Lymphoedema, not elsewhere classified | Custom compression stockings are used to manage limb volume and lymphedema control |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
99406 | Smoking and tobacco use cessation counseling, intermediate, greater than 3 minutes up to 10 minutes | Counseling on smoking cessation may be provided during the visit as part of risk modification for venous disease management |
99213 | Office or other outpatient visit for the evaluation and management of an established patient, typically 15 minutes | Common E/M visit code used when evaluating and documenting medical necessity for custom compression stockings |
93970 | Duplex scan of extremity veins, complete bilateral study | Diagnostic vascular ultrasound often performed to evaluate venous reflux or DVT prior to prescribing compression therapy |
97597 | Debridement, selective debridement; wound(s), first 20 sq cm or less | Wound care procedures performed in patients with venous stasis ulcers where compression stockings are part of management |
97760 | Orthotic(s) management and training, initial encounter | Patient training and fitting education for custom compression stockings may be billed under orthotic management codes when applicable |