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