BILLING FOR GRADIENT COMP. WRAPS

The question has come up that if a patient presents with ulcers or lymphedema, can they be treated with compression wraps and have it be covered by their insurance? The answer is, like everything in healthcare: it depends. HCPCS codes for Compression stockings A6531/ A6532, and Compression wrap A6545 are reimbursable codes, but only under specific conditions.

Under Medicare guidelines A6545 falls under the category of surgical dressings, and is covered when used in the treatment of open venous stasis ulcer. It is not covered when used for other indications such as the prevention of stasis ulcer, venous insufficiency, or treatment of lymphedema without the presence of an ulcer. Commercial payers however may have different rules. Some payers allow compression for the treatment of lipodermatosclerosis or lymphedema. It is advised to look up the guidelines for each payer and the individual policy benefits prior to engaging the patient in a treatment plan so it’s best to get health insurance consulting.

A6545 Gradient compression wrap, non-elastic, below knee, 30-50 mm hg, carries an average reimbursement rate of $95.00 each. When using to treat an open ulcer, it should be billed with an AW modifier indicating it is furnished with a surgical dressing. Modifiers RT and LT should also be appended to the code to indicate which limb the wrap is being applied to. Bilateral billing may also apply. Medicare has set a limit of one compression wrap per 6 months per leg.

Quite a few of our practices see venous stasis ulcerations, and more than a few tend to refer the patient to a wound care specialist for treatment of the ulcer. However, there are also a number of practices that prefer to treat these in house for the convenience of the patient, and adding this product is just another way to provide comprehensive care to your patients.

Editor’s Note: You do NOT have to be a DME provider to bill for these products/services.

One Response to BILLING FOR GRADIENT COMP. WRAPS

  1. Mark Seidel July 3, 2020 at 8:53 am #

    Would like some pointers on billing CMS and basic allowables

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