`A6505` Cmprsburngarment glove-elbow

Compression burn garment, glove to elbow, custom fabricated

Medicare coverage: Special coverage instructions apply
Status: active (October 2026 file)

Medically Unlikely Edits (effective October 1, 2026)

Practitioner: max 0 units per day (clinical), rationale: CMS Policy
Outpatient hospital: max 2 units per day (clinical), rationale: Nature of Equipment
DME supplier: max 4 units per day (clinical), rationale: Nature of Equipment

Medicare pricing for A6505

DMEPOS fee schedule, July 2026 (DME26-C)

no modifier, surgical dressings (SD): no amount on file (priced by the DME MAC)

Physician Fee Schedule (CY 2026, RVU26D)

Status X: statutory exclusion, not paid under the PFS.

Payer policies and prior authorization for A6505

1 of 1 payer prior-auth lists that name A6505 require prior authorization or set conditions: UnitedHealthcare Community Plan.

Payer	Plan	State	Prior auth	Conditions	Since	Source
UnitedHealthcare Community Plan	UnitedHealthcare Community Plan of Kentucky	KY	prior auth under conditions	Cost over $500	Jul 1, 2026	Prior authorization requirements for UnitedHealthcare Community Plan of Kentucky Effective July 1, 2026

Payer coverage policies that name A6505

A6505 appears in 4 coverage policies from Aetna, Blue Cross & Blue Shield of Mississippi, Blue Cross & Blue Shield of Rhode Island.

Payer	Policy	Role in policy	Reviewed	Document
Aetna	Burn Garments (0062)	covered if criteria are met	Jan 15, 2026	payer document
Aetna	Carbon Dioxide Laser (0427)	listed, no stance (range A6501-A6549)	Jul 8, 2026	payer document
Blue Cross & Blue Shield of Mississippi	Garments (L.1.04.400)	covered if criteria are met		payer document
Blue Cross & Blue Shield of Rhode Island	Compression Garments_Stockings	covered if criteria are met	Apr 1, 2026	payer document

Recent prior-auth changes

Apr 1, 2026: PA removed, UnitedHealthcare
Apr 1, 2026: PA removed, UnitedHealthcare

Medicaid fee-for-service

Prior authorization required or conditional in CO, IL, KY, LA, MA, NY, OH, VA, WA, WV.

LA: $188.00 (dme), effective Sep 1, 2021
MD: $160.64 (dme), effective Apr 1, 2026
TX: $0.00 (dmepos_tos_9_e_j_l_and_r, Home Health Dme, non-facility), effective May 1, 2003
VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026
WY: $0.00 (outpatient_hospital_apc, Children's Hospitals), effective Apr 1, 2026

From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.

A6505 Cmprsburngarment glove-elbow