Summary & Overview
HCPCS A6564: Gradient Compression Stocking, Waist Length, 40 mmHg or Greater
HCPCS Level II code A6564 represents a custom, waist-length gradient compression stocking delivering 40 mmHg or greater compression, billed per item. Nationally, this code matters because it captures high-compression, custom-fitted durable medical equipment often used in managing chronic venous disease, post-thrombotic syndrome, and lymphedema—conditions that drive ongoing outpatient and home health care needs and influence DME utilization and spending.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication outlines payer coverage patterns and benchmark comparisons, clinical context for when high-gradient, custom stockings are used, and coding nuances important for billing and claims adjudication. Readers will learn about typical sites of service where fittings occur, documentation elements relevant to medical necessity, and how coverage distinctions across major payers can affect access and reimbursement. Data not available in the input is noted where applicable.
Billing Code Overview
HCPCS Level II code A6564 describes a gradient compression stocking, waist length, 40 mmHg or greater, custom, each. This item is a custom-fitted, high-compression garment designed to provide therapeutic graduated compression of at least 40 millimeters of mercury. The service type is custom durable medical equipment (DME) for compression therapy.
The typical site of service for A6564 is outpatient clinic or home health setting, where custom fittings and measurements are performed and supplies are provided to patients requiring long-term compression for venous insufficiency, post-thrombotic syndrome, lymphedema, or other circulatory conditions.
Clinical & Coding Specifications
Clinical Context
A patient with chronic venous insufficiency or lymphedema is evaluated in an outpatient vascular clinic. The clinician documents the need for a custom, waist-length gradient compression stocking providing 40 mmHg or greater compression for unilateral or bilateral lower-extremity edema management and venous ulcer support. The workflow includes: history and physical focusing on edema, venous disease, skin integrity, and arterial perfusion; measurement of limb circumferences and waist/hip dimensions for custom fit; obtaining a prescription specifying A6564 (gradient compression stocking, waist length, 40 mmHg or greater, custom, each) with laterality and quantity; fitting appointment for measurement verification and patient education on donning/doffing, wear schedule, skin care, and replacement timing; documentation of medical necessity (e.g., failure of standard stockings, documented venous insufficiency, post-thrombotic syndrome, or chronic lymphedema). Typical site of service is an outpatient durable medical equipment (DME) supplier, vascular clinic, wound care center, or home health setting coordinated by the treating physician. Typical patient scenario: an adult with chronic venous stasis and recurrent lower-extremity swelling and a history of non-healing venous ulcer who requires a custom, waist-length compression garment delivering 40 mmHg or greater to control edema and promote ulcer healing.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 |