`A6611` Grad com wrap w strap ak cus

Gradient compression wrap with adjustable straps, above knee, each, custom

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 A6611

Physician Fee Schedule (CY 2026, RVU26D)

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

Payer policies and prior authorization for A6611

Payer coverage policies that name A6611

A6611 appears in 3 coverage policies from Blue Cross & Blue Shield of Mississippi, Blue Cross & Blue Shield of Rhode Island.

Payer	Policy	Role in policy	Reviewed	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

Medicaid fee-for-service

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

CO: $144.75 (chp_plus, non-facility), effective Jul 1, 2026
ND: $0.00 (physician), effective Aug 1, 2026
TX: $42.09 (dmepos_tos_9_e_j_l_and_r, Medical Supplier (Dme), non-facility), effective Apr 1, 2025
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.

A6611 Grad com wrap w strap ak cus