S8420 Custom gradient sleev/glov

Gradient pressure aid (sleeve and glove combination), custom made

Medicare pricing for S8420

Physician Fee Schedule (CY 2026, RVU26D)

Status I: not valid for Medicare (Medicare uses another code).

Payer policies and prior authorization for S8420

Payer coverage policies that name S8420

S8420 appears in 3 coverage policies from Aetna, Blue Cross & Blue Shield of Rhode Island.

PayerPolicyRole in policyReviewedDocument
AetnaComplex Regional Pain Syndrome (CRPS): Treatments (0447)
Ketamine metabolite (2R,6R)-hydroxynorketamine, metformin, topical ketamine, Topical dimethyl sulfoxide, Anakinra, Sarilumab -		not coveredJul 16, 2026payer document
AetnaLymphedema (0069)covered if criteria are met (range S8420-S8428)Feb 25, 2026payer document
Blue Cross & Blue Shield of Rhode IslandCompression Garments_Stockings
PAYMENT POLICY | 2		covered if criteria are metApr 1, 2026payer document

Medicaid fee-for-service

Prior authorization required or conditional in CO, IL, LA, MA, MD, OH.

  • LA: $247.50 (dme), effective Sep 1, 2021
  • TX: $333.33 (dmepos_tos_9_e_j_l_and_r, Home Health Dme, non-facility), effective Sep 1, 2025

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.