A6549 Grad com garm noc day useGradient compression garment, not otherwise specified, for daytime use, each
Status X: statutory exclusion, not paid under the PFS.
3 of 3 payer prior-auth lists that name A6549 require prior authorization or set conditions: Humana, UnitedHealthcare Community Plan.
| Payer | Plan | State | Prior auth | Conditions | Since | Source |
|---|---|---|---|---|---|---|
| Humana | Oak Street Health | All | prior auth required | Oak Street Health (Humana): Prior Authorization List (PAL) Codes Under Management | ||
| UnitedHealthcare Community Plan | Mississippi CHIP | MS | prior auth under conditions | Prior authorization is required only for the codes listed with a retail purchase or a cumulative rental cost of more than $500. | Apr 1, 2025 | Prior authorization requirements for Mississippi Children’s Health Insurance Program Effective Apr. 1, 2025 |
| UnitedHealthcare Community Plan | MississippiCAN | MS | prior auth under conditions | site of care: outpatient | Apr 1, 2025 | Prior authorization requirements for UnitedHealthcare Community Plan of Mississippi – Mississippi Coordinated Access Network (MississippiCAN) Effective Apr. 1, 2025 |
A6549 appears in 11 coverage policies from Aetna, Blue Cross & Blue Shield of Mississippi, Blue Cross & Blue Shield of Rhode Island, UnitedHealthcare.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Carbon Dioxide Laser (0427) | listed, no stance (range A6501-A6549) | Jul 8, 2026 | payer document |
| Aetna | Complex Regional Pain Syndrome (CRPS): Treatments (0447) Ketamine metabolite (2R,6R)-hydroxynorketamine, metformin, topical ketamine, Topical dimethyl sulfoxide, Anakinra, Sarilumab - | not covered | Jul 16, 2026 | payer document |
| Aetna | Compression Garments for the Legs (0482) | covered if criteria are met (range A6530-A6549) | Jul 29, 2026 | payer document |
| Aetna | External Breast Prosthesis (0097) | covered if criteria are met | Jan 15, 2026 | payer document |
| Aetna | Intermittent Pneumatic Compression Devices (0500) | listed, no stance (range A6530-A6549) | Jul 10, 2026 | payer document |
| Aetna | Lymphedema (0069) | listed, no stance (range A6530-A6549) | Feb 25, 2026 | payer document |
| Aetna | Varicose Veins (0050) | listed, no stance (range A6530-A6549) | Aug 3, 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 Mississippi | Prosthetics (L.1.04.401) | 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 |
| UnitedHealthcare | Durable Medical Equipment (DME), Prosthetics, Orthotics (Non-Foot Orthotics), Nutritional Therapy, and Medical Supplies Grid (MMP028.23) Lymphedema Compression Treatment Items | DME | Coverage criteria apply; refer to the | listed, no stance | Oct 1, 2025 | payer document |
Prior authorization required or conditional in IL, KY, LA, MA, MS, NY, OH, VA, VT, WA, WV.
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.