A gradient compression stocking described by codes CPT A6531 or CPT A6532 or a non-elastic gradient compression wrap described by code CPT A6545 is covered when it is used in the treatment of an open venous stasis ulcer.
CPT Codes For Compression Stockings (CPT A6531 & CPT A6532)
The CPT Code for compression stockings are CPT A6531, CPT A6532, and CPT A6545 are noncovered for the following conditions:
- Venous insufficiency without stasis,
- Ulcers, prevention of stasis ulcers,
- Prevention of the reoccurrence of stasis ulcers that have healed,
- Treatment of lymphedema in the absence of ulcers.
In these situations, since there is no ulcer, the stockings/wraps do not meet the definition of a surgical dressing. Gradient compression stockings described by codes CPT A6530, CPT A6533-A6544, CPT A6549 and surgical stockings described by codes CPT A4490-A4510 are noncovered for all indications because they do not meet the definition of a surgical dressing.
Coverage & Reimbursement For Compression Stockings CPT Codes
Coverage of a non-elastic gradient compression wrap (CPT A6545) is limited to one per 6 months per leg. Quantities exceeding this amount will be denied as not reasonable and necessary.
The gradient compression wrap code CPT A6545 must be billed with the AW modifier (in addition to the appropriate A1-A9 modifier). When gradient compression stocking codes CPT A6531 and CPT A6532 or the gradient compression wrap code CPT A6545 are used for an open venous stasis ulcer, the code must be billed with the AW modifier (but not an A1-A9 modifier).
Modifier For Compression Stockings CPT Codes
Codes CPT A4450, CPT A4452, CPT A6531, CPT A6532, and CPT A6545 are the only codes for which the AW modifier may be used.