Subject:
Compression Stockings
Description:
_______________________________________________________________________________________
IMPORTANT NOTE:
The purpose of this policy is to provide general information applicable to the administration of health benefits that Horizon Blue Cross Blue Shield of New Jersey and Horizon Healthcare of New Jersey, Inc. (collectively “Horizon BCBSNJ”) insures or administers. If the member’s contract benefits differ from the medical policy, the contract prevails. Although a service, supply or procedure may be medically necessary, it may be subject to limitations and/or exclusions under a member’s benefit plan. If a service, supply or procedure is not covered and the member proceeds to obtain the service, supply or procedure, the member may be responsible for the cost. Decisions regarding treatment and treatment plans are the responsibility of the physician. This policy is not intended to direct the course of clinical care a physician provides to a member, and it does not replace a physician’s independent professional clinical judgment or duty to exercise special knowledge and skill in the treatment of Horizon BCBSNJ members. Horizon BCBSNJ is not responsible for, does not provide, and does not hold itself out as a provider of medical care. The physician remains responsible for the quality and type of health care services provided to a Horizon BCBSNJ member.
Horizon BCBSNJ medical policies do not constitute medical advice, authorization, certification, approval, explanation of benefits, offer of coverage, contract or guarantee of payment.
__________________________________________________________________________________________________________________________
Compression stockings are defined as custom-made or custom-fitted pressure gradient support stockings that require prescription by a physician or qualified health care professional, and that require measurement for fitting.
Custom-fitted compression stockings are considered off the shelf. Traditionally, manufacturers make a range of sizes and then when the patient arrives to be fitted they will take 3 to 5 measurements of the patient's limb and then find the stocking that meets the patient's dimensions.
Custom-made stockings are stockings that are made for patients that do not fall into the standard dimensions of off-the-shelf stockings.
This generally requires using a specialty tape measure that has measurements every inch and a half up to the patient's leg resulting in 20 - 40 circumferences depending on the length, and then the factory will hand sew the stocking to match those circumferences.
Prescription graded compression stockings provide pressure gradient across the length of the stocking. Compression stockings are available in different pressure gradients. In addition, a variety of lengths are also available, including knee-high, thigh-high, and waist-high.
Traditionally, all custom-fitted and custom-made stockings start at 20 mmHg - 30 mmHg compression and increase from there. Compression stockings with less than 20 mmHg are usually measured by shoe size and fit like normal dress socks.
According to UpToDate, compression stocking prescriptions vary depending on the symptoms and signs of disease and patient factors. The grade of compression, stocking length, and type of stocking must be specified on the prescription. Proper measurement and fitting of the stockings, specific patient instruction, and encouragement enhance compliance with compression stockings.
Policy:
(NOTE: For Medicare Advantage, Medicaid and FIDE-SNP, please refer to the Coverage Sections below for coverage guidance.)
1. Compression stockings that have a pressure of 20 mmHg or more are considered medically necessary for any of the following indications:
a. chronic venous insufficiency
b. stasis dermatitis (venous eczema)
c. venous edema
d. lipodermatosclerosis
e. venous stasis ulcers
f. symptomatic varicose veins (except spider veins)
g. phlebitis/thrombophlebitis
h. post-thrombotic (post-phlebitic) syndrome
i. lymphedema
j. deep vein thrombosis (DVT) prophylaxis in pregnancy and postpartum
k. prevention of thrombosis in immobilized members
2. Over-the-counter (OTC) support hose/stockings/garments usually have pressure less than 20 mm Hg and are considered investigational since they have not been proven to be effective in the treatment of the above listed conditions.
Medicare Coverage:
Gradient compression stockings falling under the following codes may be covered when the beneficiary has an open venous stasis ulcer that has been treated by a physician or other healthcare professional requiring medically necessary debridement, and when the gradient stocking can be proven to deliver compression greater than 30 mm Hg. and less than 50 mm Hg. (Applicable Healthcare Common Procedure Coding System (HCPCS) Codes: L8110 - GRADIENT COMPRESSION STOCKING, BELOW KNEE, 30-40 MMHG, EACH L8120 - GRADIENT COMPRESSION STOCKING, BELOW KNEE, 40-50MMHG, EACH).
A gradient compression stocking described by codes A6531 or A6532 or a non-elastic gradient compression wrap described by code A6545 is covered when it is used in the treatment of an open venous stasis ulcer.
Codes A6531, A6532, and 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 A6530, A6533-A6544, A6549 and surgical stockings described by codes A4490-A4510 are noncovered for all indications because they do not meet the definition of a surgical dressing.
For additional information, refer to the below guidance from CMS:
Local Coverage Article: Surgical Dressings - Policy Article - Effective October 2015 (A52491). Available at: https://www.cms.gov/medicare-coverage-database/details/article-details.aspx?articleId=52491&ver=3&LCDId=33831&ContrId=389&ContrVer=1&CntrctrSelected=389*1&Cntrctr=389&s=38&DocType=All&bc=AggAAAQAIAAAAA%3d%3d&.
National Coverage Determination (NCD) for Durable Medical Equipment (DME) Reference List (280.1). Available to be accessed at CMS National Coverage Determinations (NCDs) Alphabetical Index search page: https://www.cms.gov/medicare-coverage-database/indexes/ncd-alphabetical-index.aspx
Local Coverage Determination (LCD): Surgical Dressings (L33831).
Available to be accessed at Noridian Healthcare Services, LLC, (DME MAC), Local Coverage Determinations (LCDs) search page: https://www.cms.gov/medicare-coverage-database/indexes/lcd-list.aspx?Cntrctr=389&ContrVer=1&CntrctrSelected=389*1&s=38&DocType=All&bc=AggAAAAAAAAAAA%3d%3d&#ResultsAnchor.
Medicaid Coverage:
For members enrolled in Medicaid and NJ FamilyCare plans, Horizon BCBSNJ applies the above medical policy.
FIDE SNP:
For members enrolled in a Fully Integrated Dual Eligible Special Needs Plan (FIDE-SNP): (1) to the extent the service is covered under the Medicare portion of the member’s benefit package, the above Medicare Coverage statement applies; and (2) to the extent the service is not covered under the Medicare portion of the member’s benefit package, the above Medicaid Coverage statement applies.
(NOTE: According to UpToDate, "Compression stockings used for treating chronic venous disease need to exert a minimum of 20 to 30 mmHg pressure at the ankle to be effective. The white 'anti-embolism' stockings commonly given to patients in the hospital exert only 8 to 10 mmHg pressure at the ankle and are not an adequate treatment of venous insufficiency. A higher grade compression stockings (30 to 40 mmHg) may be needed with more severe chronic venous disease. Higher grade compression garments (e.g., 40 to 50 mmHg or 50 to 60 mmHg) are available but are usually reserved for patients with chronic lymphedema or in the management of burn scars.")
________________________________________________________________________________________
Horizon BCBSNJ Medical Policy Development Process:
This Horizon BCBSNJ Medical Policy (the “Medical Policy”) has been developed by Horizon BCBSNJ’s Medical Policy Committee (the “Committee”) consistent with generally accepted standards of medical practice, and reflects Horizon BCBSNJ’s view of the subject health care services, supplies or procedures, and in what circumstances they are deemed to be medically necessary or experimental/ investigational in nature. This Medical Policy also considers whether and to what degree the subject health care services, supplies or procedures are clinically appropriate, in terms of type, frequency, extent, site and duration and if they are considered effective for the illnesses, injuries or diseases discussed. Where relevant, this Medical Policy considers whether the subject health care services, supplies or procedures are being requested primarily for the convenience of the covered person or the health care provider. It may also consider whether the services, supplies or procedures are more costly than an alternative service or sequence of services, supplies or procedures that are at least as likely to produce equivalent therapeutic or diagnostic results as to the diagnosis or treatment of the relevant illness, injury or disease. In reaching its conclusion regarding what it considers to be the generally accepted standards of medical practice, the Committee reviews and considers the following: all credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, physician and health care provider specialty society recommendations, the views of physicians and health care providers practicing in relevant clinical areas (including, but not limited to, the prevailing opinion within the appropriate specialty) and any other relevant factor as determined by applicable State and Federal laws and regulations.
___________________________________________________________________________________________________________________________
Index:
Compression Stockings
Gradient Support Stockings
Stockings, Gradient Support
References:
1. El-Sheikha J, Carradice D, Nandhra S, et al. Systematic review of compression following treatment for varicose veins. Br J Surg 2015 Jun; 102(7):719-25.
2. Michiels JJ, Michiels JM, Moossdorff W, et al. Diagnosis of deep vein thrombosis, and prevention of deep vein thrombosis recurrence and the post-thrombotic syndrome in the primary care medicine setting anno 2014. World J Crit Care Med 2015 Feb 4; 4(1):29-39.
3. Cox JB, Weaver KJ, Neal DW, et al. Decreased incidence of venous thromboembolism after spine surgery with early multimodal prophylaxis: Clinical article. J Neurosurg Spine 2014 Oct; 21(4):677-84.
4. Bouman A, Cate-Hoek AT. Timing and duration of compression therapy after deep vein thrombosis. Phlebology 2014 May 19; 29(1 Suppl):78-82.
5. Carpenter P, Allaert FA, Chudek J, et al. Phlebotonic and compression stocking therapy in venous edema management: an overview of recent advances with a focus on Cyclo 3 Fort and progressive compression stockings. Womens Health (Lond Engl) 2013 Jul; 9(4):325-33.
6. Mosti G. Post-treatment compression: duration and techniques. Phlebology 2013 Mar; 28 Suppl 1:21-4.
7. O'Meara S, Cullum N, Nelson EA, et al. Compression for venous leg ulcers. Cochrane Database Syst Rev 2012 Nov 14; 11:CD000265.
8. Wagner S. Lymphedema and lipedema - an overview of conservative treatment. Vasa 2011 Jul; 40(4):271-9.
9. Kearon C, Kahn SR, Agnelli G, et al. Antithrombotic therapy for venous thromboembolic disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 2008 Jun; 133(6 Suppl):454S-%45S.
10. Alguire PC, Mathes BM. Medical management of lower extremity chronic venous disease. In: UpToDate, Eidt JF, Mills Sr JL, Collins KA (Eds), UpToDate, Waltham, MA. (Accessed on May 9, 2017).
11. Pai M, Douketis JD. Prevention of venous thromboembolic disease in acutely ill hospitalized medical adults. In: UpToDate, Leung LL, Mandel J, Finlay G (Eds), UpToDate, Waltham, MA. (Accessed on May 9, 2017.)
12. Alguire PC, Mathes BM. Post-thrombotic (postphlebitic) syndrome. In: UpToDate, Eidt JF, Mills Sr JL, Collins KA (Eds), UpToDate, Waltham, MA. (Accessed on May 9, 2017.)
13. Armstrong DG, Meyr AJ. Compression therapy for the treatment of chronic venous insufficiency. In: UpToDate, Mills Sr JL, Eidt JF, Collins KA (Eds), UpToDate, Waltham, MA. (Accessed on May 9, 2017.)
14. Pai M, Douketis JD. Prevention of venous thromboembolic disease in surgical patients. In: UpToDate, Leung LL, Mandel J, Finlay G (Eds), UpToDate, Waltham, MA. (Accessed on May 9, 2017.)
15. Ishida K. Medical complications of stroke. In: UpToDate, Kasner SE, Dashe JF (Eds), UpToDate, Waltham, MA. (Accessed on May 9, 2017.)
16. Schwartz DR, Malhotra A, Weinberger SE. Deep vein thrombosis and pulmonary embolism in pregnancy: Prevention. In: UpToDate, Leung LL, Lockwood CJ, Mandel J, Finlay G (Eds), UpToDate, Waltham, MA. (Accessed on May 9, 2017.)
17. Skervin AL, Thapar A, Franchini AJ, et al. Systematic Review and Meta-Analysis of Utility of Graduated Compression Stockings in Prevention of Post-Thrombotic Syndrome. Eur J Vasc Endovasc Surg 2016 Mar 26 [Epub ahead of print]
18. Schwartz DR, Malhotra A, Weinberger SE. Deep vein thrombosis and pulmonary embolism in pregnancy: Prevention. In: UpToDate, Leung LL, Lockwood CJ, Mandel J, Finlay G (Eds), UpToDate, Waltham, MA. (Accessed on March 27, 2018.)
Codes:
(The list of codes is not intended to be all-inclusive and is included below for informational purposes only. Inclusion or exclusion of a procedure, diagnosis, drug or device code(s) does not constitute or imply authorization, certification, approval, offer of coverage or guarantee of payment.)
CPT*
HCPCS
A6530
A6531
A6532
A6533
A6534
A6535
A6536
A6537
A6538
A6539
A6540
A6541
A6544
A6545
A6549
* CPT only copyright 2020 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.
_________________________________________________________________________________________
Medical policies can be highly technical and are designed for use by the Horizon BCBSNJ professional staff in making coverage determinations. Members referring to this policy should discuss it with their treating physician, and should refer to their specific benefit plan for the terms, conditions, limitations and exclusions of their coverage.
The Horizon BCBSNJ Medical Policy Manual is proprietary. It is to be used only as authorized by Horizon BCBSNJ and its affiliates. The contents of this Medical Policy are not to be copied, reproduced or circulated to other parties without the express written consent of Horizon BCBSNJ. The contents of this Medical Policy may be updated or changed without notice, unless otherwise required by law and/or regulation. However, benefit determinations are made in the context of medical policies existing at the time of the decision and are not subject to later revision as the result of a change in medical policy
____________________________________________________________________________________________________________________________ |