CODING, COVERAGE AND REIMBURSEMENT

This section currently focuses primarily on Medicare. It may be expanded in the future to include information on private insurers as well.

General 

• Overall, compression bandages, wraps and certain gradient compression stockings are covered by Medicare part B as long as used on patients with a venous stasis ulcer (VLU) that meet the requirements to be a qualified wound (surgically created or modified, or debrided). These items are only covered if used at the beneficiary's residence (place of service 12) and are not separately payable if items are supplied at physician's office or hospital outpatient department.
• Medicare coverage of compression devices, including compression bandages, is managed by Medicare Administrative Contractors (MAC). Coverage is explained by the:
• Local Coverage Determination (LCD) Surgical Dressings (L33831) [1] , and
• Local Coverage Article: Surgical Dressings - Policy Article (A54563)  [2]
• The frequency of recommended dressing changes depends on the type and use of the surgical dressing. When combinations of primary dressings, secondary dressings, and wound filler are used, the change frequencies of the individual products should be similar. According to the Surgical Dressings Policy [3] , the product in contact with the wound determines the change frequency. It is not reasonable and necessary to use a combination of products with differing change intervals. For example, it is not reasonable and necessary to use a secondary dressing with a weekly change frequency over a primary dressing with a daily change interval. Such claims will be denied as not reasonable and necessary.
• The following items are covered by Medicare Part B when requirements are met: 

Multi-layer compression bandage systems

• HCPCS: Light Compression Bandage (A6448-A6450), Moderate/High Compression Bandage (A6451, A6452), Self-Adherent Bandage (A6453-A6455), Conforming Bandage (A6442-A6447), Padding Bandage (A6441)
• Coverage requirements:
• Compression bandages and multi-layer systems are only covered when they are used as a primary or secondary dressing over wound that meet the statutory requirements for a qualifying wound (surgically created or modified, or debrided).
• Claims for compression bandages and multi-layer systems used without a qualifying wound or when used for other non-qualifying conditions will be denied as statutorily non-covered, no benefit. Refer to the related Policy Article non-medical necessity coverage and payment rules for information about the statutory benefit requirements
• Frequency of replacement allowed by Medicare:
• Most compression bandages are reusable. Frequency of replacement would be no more than one per week unless they are part of a multi-layer compression bandage system.
• Conforming bandage dressing change is determined by the frequency of change of the selected underlying dressing.

• Non-covered conditions:
• Strains, sprains, edema,
• Situations other than as a dressing for a qualified wound (VLU that has been debrided)
• Billing reminders:
• When multi-layer compression bandage systems are used for the treatment of a venous stasis ulcer, each component is billed using a specific code for the component - e.g., moderate or high compression bandages (A6451, A6452), conforming bandages (A6443, A6444), self-adherent bandages (A6454), padding bandages (A6441), zinc paste impregnated bandage (A6456)
• Medicare billable unit for bandages used in multilayer systems are "per yard".
• When billing Medicare, check number of yards per bandage as described by manufacturer and indicate number of units (i.e., yards) to be used during the period for which supplies are being requested. As per Medicare Policy: "For all dressings, if a single dressing is divided into multiple portion/pieces, the code and quantity billed must represent the originally manufactured size and quantity".

Zinc Paste Impregnated Bandage (Unna boots)

• HCPCS: (A6456)
• Coverage requirements: VLU that meet the statutory requirements for a qualifying wound (surgically created or modified, or debrided).
• Frequency of replacement allowed by Medicare: 1 time/week
• Non-covered conditions: Non-qualifying wounds (see coverage requirements above)

Contact Layer

• HCPCS: (A6206-A6208)
• Coverage requirements: wound that has been surgically created or modified, or debrided
• Frequency of replacement allowed by Medicare: 1 time /week. They are not intended to be changed with each dressing change. 
• Non-covered conditions: Contact layer dressings are used to line the entire wound to prevent adhesion of the overlying dressing to the wound. They are not reasonable and necessary when used with any dressing that has a non-adherent or semi-adherent layer as part of the dressing. 

HCPCS Modifiers

• Claims for compression bandages without the A1-A9 modifiers below will be rejected by the MAC. 
• Modifiers A1 – A9 have been established to indicate that a particular item is being used as a primary or secondary dressing on a surgical or debrided wound and to indicate the number of wounds on which that dressing is being used. The modifier number must correspond to the number of wounds on which the dressing is being used, not the total number of wounds treated. For example, if the beneficiary has four (4) wounds but a particular dressing is only used on two (2) of them, the A2 modifier must be used with that HCPCS code
• A1 – Dressing for one wound 
• A2 – Dressing for two wounds 
• A3 – Dressing for three wounds 
• A4 – Dressing for four wounds 
• A5 – Dressing for five wounds 
• A6 – Dressing for six wounds 
• A7 – Dressing for seven wounds 
• A8 – Dressing for eight wounds 
• A9 – Dressing for nine wounds 
• AW – Item furnished in conjunction with a surgical dressing 
• EY – No physician or other licensed health care provider order for this item or service 
• GY – Item or service statutorily noncovered or does not meet the definition of any Medicare benefit 
• LT – Left side 
• RT – Right side