`S8423` Custom grad sleeve heavy

Gradient pressure aid (sleeve), custom made, heavy weight

Medicare coverage: Not payable by Medicare
Status: active (October 2026 file)

Medicare pricing for S8423

Physician Fee Schedule (CY 2026, RVU26D)

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

Payer policies and prior authorization for S8423

Payer coverage policies that name S8423

S8423 appears in 4 coverage policies from Aetna, 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	Jul 16, 2026	payer document
Aetna	External Breast Prosthesis (0097)	covered if criteria are met	Jan 15, 2026	payer document
Aetna	Lymphedema (0069)	covered if criteria are met (range S8420-S8428)	Feb 25, 2026	payer document
Blue Cross & Blue Shield of Rhode Island	Compression Garments_Stockings PAYMENT POLICY \| 3	covered if criteria are met	Apr 1, 2026	payer document

Medicaid fee-for-service

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

CO: $127.14 (health_first_colorado), effective Jul 1, 2026
LA: $149.27 (dme), effective Sep 1, 2021
TX: $137.76 (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.

S8423 Custom grad sleeve heavy