Currentpriority healthPolicy 067

COMPRESSION GARMENTS

Defines Priority Health's reimbursement, billing, and documentation guidelines for compression garments (lymphedema/related) including frequency, modifiers, and place-of-service considerations for providers submitting claims.

Policy Summary

Payerpriority health

PolicyCompression Garments

Policy CodePolicy 067

Change TypeReviewed — no material changes

Effective Date

Next Review DateFeb 1, 2026

Key ActionObtain a Pre‑Service Organization Determination (PSOD) for Medicare indications that do not meet NCD/LCD or specific medical policy.

SourceLink

POLICY UPDATE CHANGES

Added 'Disclaimer' section.

Policy was reviewed with no changes on Feb. 19, 2026.

3/6mDaytime garments allowed per affected body part

2/2yNighttime garments allowed per affected body part

AllowedMultiple body parts allowed

KXModifier guidance (DME)

CPT 29581/29584Bandaging systems payment

Policy Summary

Payerpriority health

PolicyCompression Garments

Policy CodePolicy 067

Change TypeReviewed — no material changes

Effective Date

Next Review DateFeb 1, 2026

Key ActionObtain a Pre‑Service Organization Determination (PSOD) for Medicare indications that do not meet NCD/LCD or specific medical policy.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Compression garment coverage and billing rules

Covered when ALL of the following criteria, limits, documentation, and modifier requirements are met:

Coverage is permitted only when providers follow the specified frequency limits, documentation requirements, and modifier/billing rules.

Billing for more than one body part or area and for both a daytime and nighttime garment for the same body part is allowed.

CPT codes 29581 and 29584 include payment for lymphedema compression treatment bandaging systems; Level II HCPCS A codes for these bandaging systems are not separately payable when billed with these CPT codes.

Providers must follow CMS standard documentation requirements for supplies and DME (see CMS Article A55426) and fully document services/items to substantiate the procedure performed.

ALL of the following

Apply modifiers according to CMS NCCI and Priority Health guidance; modifiers must be supported by documentation.
HCPCS / DME modifier guidance
- Use anatomic modifiers when appropriate.
- AW modifier: item furnished in conjunction with a surgical dressing.
- RA modifier: use when billing for a replacement.
- KX modifier: append to indicate that policy criteria have been met for all DME items.
- Medicare only: one of KX, GA, GY, or GZ may be required per CMS/local coverage requirements for DME claim processing.

Incorrect application of modifiers may result in claim denials; consult the Provider Manual for additional modifier guidance and examples.

Relevant CPT/HCPCS Codes and Frequency Limits

Covered CPT CodesCPTCovered

29581	Compression treatment bandaging system (CPT) — payment includes bandaging systems
29584	Compression treatment bandaging system (CPT) — payment includes bandaging systems

HCPCS Modifiers and Billing InteractionsHCPCS

AW	Item furnished in conjunction with a surgical dressing
RA	Should be used when billing for a replacement
KX	Modifier should be appended to indicate that policy criteria have been met for all DME items
GA	Medicare modifier — per CMS local coverage determinations, required for claim processing of DME items
GY	Medicare modifier — per CMS local coverage determinations, required for claim processing of DME items
GZ	Medicare modifier — per CMS local coverage determinations, required for claim processing of DME items

Non-payable when billed with CPT 29581/29584HCPCSNot Covered

Level II HCPCS A codes

Lymphedema compression treatment bandaging systems Level II HCPCS A codes — not separately payable when billed in conjunction with CPT 29581 or 29584

Frequency limits per affected body part

Daytime allowanceUp to 3 garments per affected body part every 6 months

Nighttime allowanceUp to 2 garments per affected body part every 2 years

Replacement allowance — lost/stolen/damagedReplacements permitted as needed to replace lost, stolen, or irreparably damaged items

Replacement allowance — clinical changeReplacements permitted if patient condition changes (e.g., change in limb size)

Authorization and Pre-Service Requirements

Prior Authorization

Pre-Service Organization Determination (PSOD) required for Medicare indications

For Medicare patients when the indication does not meet an NCD, local LCD, or a specific medical policy, the provider must submit a Pre-Service Organization Determination (PSOD) before providing services. See the Provider Manual for PSOD submission details and requirements.

PSOD required when indications do not meet NCD/LCD/specific medical policy.
Authorization may also be required depending on place-of-service—confirm via the Provider Manual.

OpenPayer

COMPRESSION GARMENTS

Compression Garment Coverage and Billing Rules

Relevant CPT/HCPCS Codes and Frequency Limits

Authorization and Pre-Service Requirements

Key Definitions