Article Detail - JD DME
RETIRED - Compression Bandage Systems
Article retired due to content incorporation into the applicable Local Coverage Determination or related Policy Article.
Original Effective Date: 03/15/2002
Revision Effective Date: 11/01/2013
A revision of the Surgical Dressings policy in the accompanying DMERC Region D Supplier Manual update includes coverage for multi-layer compression bandage systems when they are used in the treatment of venous stasis ulcers. The revised policy is effective for claims with dates of service on or after April 1, 2002. When a multi-layer compression bandage system is provided, each component is billed using a specific code for the component if available; the multi-layer kit may not be billed as a single unit under the miscellaneous code A4649. Code A4460 is used for traditional elastic bandages as well as for other short-stretch and long-stretch compression bandages and for self-adherent cohesive compression bandages. The unit of service for code A4460 is one roll, regardless of the length or width. Codes A6263 for elastic roll gauze and/or code A6264 for nonelastic roll gauze are used when appropriate. The unit of service for these codes is one linear yard. Zinc oxide paste impregnated roll gauze bandages (e.g., Unna Boot and multiple other brand names) are billed using code A6266. The unit of service of this code is one linear yard. Components of multi-layer compression bandage systems that do not have a specific code (e.g., cotton or synthetic padding roll) are billed with the miscellaneous surgical supply code A4649.
Gradient compression stockings are also eligible for coverage under the Surgical Dressings benefit when they are used as part of a multi-layer compression system for the treatment of venous stasis ulcers. In these situations, code A4649 must be used. Codes L8100-L8239 will continue to be used for compression stockings that are provided to patients who do not have a venous stasis ulcer at the time they are dispensed. These codes will continue to be denied as noncovered.
Claims for code A4649 must include the brand name and manufacturer of the item that is provided and a brief description of the item to explain why it doesn't fall under a specific HCPCS code.
Code A4465 (non-elastic binder for extremity) remains noncovered in all situations.
It is important to note that compression bandage systems and gradient compression stockings are only eligible for coverage under the Surgical Dressings benefit when they are used in the treatment of a venous stasis ulcer. The X1-X9 modifier (as appropriate for the number of ulcers) must be added to the code if this coverage criterion is met. When these items are used for the treatment of venous insufficiency, lymphedema, or edema of other causes in the absence of an ulcer or surgical wound, they are denied as statutorily noncovered.
Last Updated Thu, 10 Jan 2019 12:35:45 +0000