Compression garments (stockings, burn garments, gradient pressure aids) coverage criteria
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This policy governs coverage of prescription compression garments and stockings (including burn garments and gradient pressure aids) when ordered by a physician and obtained from a DME provider for Blue Cross Blue Shield - Rhode Island members.
No material clinical or coverage changes in this revision.
Coverage Criteria
General coverage criteria
Covered when ALL of the following are met
Requires physician order
DME provider must file HCPCS codes
For all other items, CMS MUE guidelines apply
Over-the-counter (OTC) support hose, stockings, and non-prescription fabric supports are explicitly excluded from coverage. These items — for example, medical support hose, elastic stockings that have no degree of graduated pressure, and surgical leggings — are considered non-covered and are the member's financial responsibility. Coverage under this policy applies only to prescription compression garments/stockings that are ordered by a physician and obtained from a durable medical equipment provider.
Coding and Supplies
| A6501 | Compression burn garment, bodysuit (head to foot), custom fabricated |
| A6502 | Compression burn garment, chin strap, custom fabricated |
| A6503 | Compression burn garment, facial hood, custom fabricated |
| A6504 | Compression burn garment, glove to wrist, custom fabricated |
| A6505 | Compression burn garment, glove to elbow, custom fabricated |
| A6506 | Compression burn garment, glove to axilla, custom fabricated |
| A6507 | Compression burn garment, foot to knee length, custom fabricated |
| A6508 | Compression burn garment, foot to thigh length, custom fabricated |
| A6509 | Compression burn garment, upper trunk to waist including arm openings (vest), custom fabricated |
| A6510 | Compression burn garment, trunk, including arms down to leg openings (leotard), custom fabricated |
| A6539 | Gradient compression stocking, waist length, 18-30 mm Hg, each |
| A6540 | Gradient compression stocking, waist length, 30-40 mm Hg, each |
| A6541 | Gradient compression stocking, waist length, 40-50 mm Hg, each |
| A6543 | Gradient compression stocking, lymphedema |
| A6544 | Gradient compression stocking, garter belt |
| A6549 | Gradient compression stocking, not otherwise specified (code requires submission of invoice for payment) |
| S8420 | Gradient pressure aid (sleeve and glove combination), custom made |
| S8421 | Gradient pressure aid (sleeve and glove combination), ready made |
| S8422 | Gradient pressure aid (sleeve), custom made, medium weight |
| S8423 | Gradient pressure aid (sleeve), custom made, heavy weight |
Provider Actions and Billing
Prior authorization not applicable
Prior authorization is not required for compression garments and stockings under this policy.
No step therapy required
The policy does not impose any step therapy requirements for coverage of compression garments or stockings.
OTC non-prescription compression items are member liability
Over-the-counter (OTC) support hose, stockings, and garments that are non-prescription and non-graded (e.g., medical support hose, fabric supports, elastic stockings with no degree of pressure, surgical leggings) are not covered and are the member's financial responsibility.
- Dispensing OTC non-prescription, non-graded compression items will be member liability.
DME Medical Necessity Criteria
DME medical necessity criteria
Medical necessity considerations
Higher pressure garments require prescription and trained fitter
Custom fabrication may take 6-8 weeks
Over-the-counter stockings are lower grade, may not be graduated, and are not covered
Rental and Purchase Rules
| Item | Purchase/rental rule | Notes / limits |
|---|---|---|
| Compression garments/stockings | ||
| Purchase (obtained from a DME provider) | ||
| Member may be dispensed up to 8 stockings or 4 pairs per 12 months after the initial dispensed compression garment(s)/stocking(s). Other items follow CMS MUE guidelines. OTC support hose/stockings/garments are not covered and are member liability. |
Replacement Frequency
Definitions
Documentation Requirements
Invoice and documentation requirements for A6549 and higher-pressure garments
For code A6549, the policy requires submission of the invoice for payment; additionally, higher-pressure stockings require a physician prescription and fitting/measuring by a specially trained individual documented in the record.
- A6549: “code requires submission of invoice for payment.”
- Higher pressure stockings require a prescription and fitting/measuring by a specially trained individual.
Not Covered
Not covered: OTC compression stockings/support hose and other non‑prescription lower‑grade compression items. Examples include medical support hose or elastic stockings without a defined degree of compression and surgical leggings. Dispensing these OTC items will be member liability and are not eligible for reimbursement under this policy.
Background
Compression garments are typically fitted elastic support garments (stockings, burn garments, gradient pressure aids, sleeves) designed to apply graduated pressure to improve venous return, reduce edema, support the muscle pump, and assist in burn therapy. Under this policy, covered compression garments and stockings must be ordered by a physician and obtained from a durable medical equipment (DME) provider. Note that most garments can be pre‑made; custom fabrication is uncommon and, when required, may take several weeks. A member may be dispensed up to 8 stockings or 4 pairs per 12 months after the initial dispensed compression garment(s)/stocking(s).
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