`A6564` G com stckng waist 40+ cust

Gradient compression stocking, waist length, 40 mmhg or greater, custom, each

Medicare coverage: Carrier judgment
Status: active (October 2026 file)

Medically Unlikely Edits (effective October 1, 2026)

DME supplier: max 6 units per day (policy), rationale: CMS Policy

Medicare pricing for A6564

DMEPOS fee schedule, July 2026 (DME26-C)

no modifier, lymphedema compression treatment (LC): non-rural $1,093.78 in the contiguous states; $1,093.78 in AK, HI, PR and VI

Physician Fee Schedule (CY 2026, RVU26D)

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

Payer policies and prior authorization for A6564

1 of 1 payer prior-auth lists that name A6564 require prior authorization or set conditions: Humana.

Payer	Plan	State	Prior auth	Conditions	Since	Source
Humana	Humana Healthy Horizons	VA	prior auth required		Jan 1, 2027	Humana Healthy Horizons in Virginia Prior Authorization and Notification List (PAL)

Payer coverage policies that name A6564

A6564 appears in 7 coverage policies from Aetna, Anthem, Blue Cross & Blue Shield of Mississippi, Blue Cross & Blue Shield of Rhode Island.

Payer	Policy	Role in policy	Reviewed	Document
Aetna	Complex Regional Pain Syndrome (CRPS): Treatments (0447) Ketamine metabolite (2R,6R)-hydroxynorketamine, metformin, topical ketamine, Topical dimethyl sulfoxide, Anakinra, Sarilumab -	not covered (range A6552-A6565)	Jul 16, 2026	payer document
Aetna	Compression Garments for the Legs (0482)	covered if criteria are met (range A6552-A6564)	Jul 29, 2026	payer document
Aetna	Lymphedema (0069)	listed, no stance (range A6552-A6564)	Feb 25, 2026	payer document
Anthem	Lower Extremity Pressure Gradient Compression Stockings (CG-DME-57)	covered if criteria are met	Aug 13, 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 PAYMENT POLICY \| 2	covered if criteria are met	Apr 1, 2026	payer document

Recent prior-auth changes

Jan 1, 2027: PA added, Humana

Medicaid fee-for-service

Prior authorization required or conditional in MA, NY, OH, VA, WA.

AZ: $1305.32 (dme), effective Oct 1, 2026
CO: $516.79 (health_first_colorado), effective Jul 1, 2026
IN: $905.27 (professional, Advanced Practice Nurse (85%), non-facility), effective Jan 1, 2026
KS: $875.02 (default), effective Jul 1, 2026
ND: $0.00 (physician), effective Aug 1, 2026
NY: $827.20 (dme), effective Jul 1, 2026
VA: $984.40 (dme), effective Dec 1, 2026
VT: $910.59 (outpatient_hospital_opps), effective Feb 1, 2026
WA: $1093.78 (medical_equipment_supplies), effective Jul 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.

A6564 G com stckng waist 40+ cust