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Medical Policy Implementation: Compression Stockings

Effective January 4, 2016, Horizon Blue Cross Blue Shield of New Jersey will change the way we consider certain claims for compression stockings.

According to the guidelines of our Compression Stockings medical policy, compression stockings that have a pressure of 20 mmHg or more are considered medically necessary for any of the following indications:

  • Chronic venous insufficiency
  • Deep vein thrombosis (DVT) prophylaxis in pregnancy and postpartum
  • Lipodermasclerosis
  • Lymphedema
  • Phlebitis/thrombophlebitis
  • Post-thrombotic (post-phlebitic) syndrome
  • Prevention of thrombosis in immobilized members
  • Stasis dermatitis (venous eczema)
  • Symptomatic varicose veins (except spider veins)
  • Venous edema
  • Venous stasis ulcers

Over-the-counter (OTC) support hose/stockings/garments generally have pressure less than 20 mm Hg.  According to the guidelines of our Compression Stockings medical policy, such items are considered investigational since they have not been proven to be effective in the treatment of the above-noted conditions.

Based on the guidelines included in our medical policy, Compression Stockings,, AND the submitted diagnosis or diagnoses code(s), HCPCS codes A6530, A6531, A6532, A6533, A6534, A6535, A6536, A6537, A6538, A6539, A6540, A6541, A6544, A6545 or A6549 submitted on claims for services provided on and after January 4, 2016 may be denied as investigational.

Review this revised policy in our online Medical Policy Manual.

Unless Horizon BCBSNJ gives written notice that all or part of the above changes have been cancelled or postponed, the changes will be applied to claims for dates of service on and after January 4, 2016.
 

Published on: October 2, 2015, 12:15 p.m. ET
Last updated on: November 24, 2020, 23:44 p.m. ET