`S8426` Custom grad glove heavy

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

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

Medicare pricing for S8426

Physician Fee Schedule (CY 2026, RVU26D)

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

Payer policies and prior authorization for S8426

Payer coverage policies that name S8426

S8426 appears in 2 coverage policies from Aetna, Blue Cross & Blue Shield of Rhode Island.

Payer	Policy	Role in policy	Reviewed	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, MA, MD, OH.

CO: $239.08 (health_first_colorado), effective Jul 1, 2026
TX: $280.02 (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.

S8426 Custom grad glove heavy