A6564 — Gradient compression stocking, waist length, 40 mmhg or greater, custom, each
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
0.00
Facility
N/A
Non-Facility
N/A
Key Coverage Criteria
- An initial purchase of two (2) pairs (2 units) of individually fitted prescription lower extremity gradient compression stockings are consideredmedically necessaryfor individuals who require treatment foranyof the following conditions:
- Edema, stasis, varicose veins, or any other disorder of the lower extremity circulation;or
- Lipedema;or
- Lipodermatosclerosis;or
- Lymphedema;or
- Postural hypotension;or
1 Active Policy
ANTHEM-CG-DME-57 — CG-DME-57 Lower Extremity Pressure Gradient Compression Stockings
Related Codes
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