Correct Coding for Items Used to Treat Edema - Revised


Joint DME MAC Publication

Edema is swelling caused by the accumulation of excessive fluid in subcutaneous tissues.  Many products are used to provide treatment for this condition; however, Medicare reimbursement for edema treatments is limited to pneumatic compression devices and certain types of multi-component compression bandage systems. Coverage is available when the beneficiary meets the specified criteria in the Local Coverage Determinations (LCDs) - Pneumatic Compression Devices and Surgical Dressings, respectively.

Other items are non-covered by Medicare when used for the treatment of edema because they do not fall into a statutory benefit category. Some common examples of these non-covered items are (not all-inclusive):

• A4465 NON-ELASTIC BINDER FOR EXTREMITY

   - Includes non-elastic binders for upper and lower extremity.

• A4467 BELT, STRAP, SLEEVE, GARMENT, OR COVERING, ANY TYPE

   - Includes compression bras, elastic binders, compression gloves, elastic knee and ankle supports or other types of elastic and non-elastic devices.

• A6530 GRADIENT COMPRESSION STOCKING, BELOW KNEE, 18-30 MMHG, EACH

• A6531 GRADIENT COMPRESSION STOCKING, BELOW KNEE, 30-40 MMHG, EACH

• A6532 GRADIENT COMPRESSION STOCKING, BELOW KNEE, 40-50 MMHG, EACH

• A6533 GRADIENT COMPRESSION STOCKING, THIGH LENGTH, 18-30 MMHG, EACH

• A6534 GRADIENT COMPRESSION STOCKING, THIGH LENGTH, 30-40 MMHG, EACH

• A6535 GRADIENT COMPRESSION STOCKING, THIGH LENGTH, 40-50 MMHG, EACH

• A6536 GRADIENT COMPRESSION STOCKING, FULL LENGTH/CHAP STYLE, 18-30 MMHG, EACH

• A6537 GRADIENT COMPRESSION STOCKING, FULL LENGTH/CHAP STYLE, 30-40 MMHG, EACH

• A6538 GRADIENT COMPRESSION STOCKING, FULL LENGTH/CHAP STYLE, 40-50 MMHG, EACH

• A6539 GRADIENT COMPRESSION STOCKING, WAIST LENGTH, 18-30 MMHG, EACH

• A6540 GRADIENT COMPRESSION STOCKING, WAIST LENGTH, 30-40 MMHG, EACH

• A6541 GRADIENT COMPRESSION STOCKING, WAIST LENGTH, 40-50 MMHG, EACH

• A6544 GRADIENT COMPRESSION STOCKING, GARTER BELT

• A6545 GRADIENT COMPRESSION WRAP, NON-ELASTIC, BELOW KNEE, 30-50 MM HG, EACH

• A6549 GRADIENT COMPRESSION STOCKING/SLEEVE, NOT OTHERWISE SPECIFIED

   - Includes custom fabricated items.

• L8010 BREAST PROSTHESIS, MASTECTOMY SLEEVE

• A9283 FOOT PRESSURE OFF LOADING/ SUPPORTIVE DEVICE, ANY TYPE, EACH.

   - See also article HCPCS Code A9283 – Devices Used for Edema or Ulcer Healing

For other non-covered items that do not fall within a specific code, A9270 (NON-COVERED ITEM OR SERVICE) is the appropriate code to bill to Medicare. Use of a miscellaneous or NOC code for billing of a non-covered item when a specific code exists is incorrect coding.

Correct coding is an essential element for correct claim payment. The PDAC contractor maintains a variety of resources to assist suppliers in determining the appropriate code for Medicare billing. For questions about correct coding, contact the PDAC Contact Center at (877) 735-1326 during the hours of 8:30 a.m. to 4:00 p.m. CT, Monday through Friday, or email the PDAC by completing the DME PDAC Contact Form. See the Contact Us webpage for details.

 

Revision History

Date Update
10/27/2006 Published on SADMERC website
12/21/2018 Revised


Last Updated: 12/21/2018