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CGS Associates, LLC

December 24, 2008

Surgical Dressings Billing Instruction for HCPCS Code A6545

Recent revisions to the Local Coverage Determination (LCD) for Surgical Dressings and the related Policy Article were published with an effective date of January 1, 2009. The Policy Article revision neglected to include billing instructions for HCPCS Code A6545.

A6545 GRADIENT COMPRESSION WRAP, NON-ELASTIC, BELOW KNEE 30-50 MM HG, EACH

Similar to codes A6531 and A6532 (compression stockings) which are addressed in the Policy Article Coding Guidelines section, HCPCS modifiers A1-A9 are not to be used with A6545.

When a gradient compression wrap, A6545, is used for an open venous stasis ulcer, the code must be billed with the AW modifier. If there is no open ulcer, the AW modifier must not be used. Claims for code A6545 without an AW modifier will be denied as statutorily noncovered.

The right (RT) and left (LT) modifiers must also be used with this code. When the same code for bilateral items (left and right) is billed on the same date of service, bill both items on the same claim line using LTRT modifiers and 2 units of service.

These guidelines will be included in a future revision of the Surgical Dressings medical policy.

The only products that may be billed with code A6545 (non-elastic compression wrap) are those which have received a written Coding Verification Review from the Pricing, Data Analysis, and Coding (PDAC) contractor and that are posted in the Product Classification List on the PDAC web site.

Suppliers should review the entire Surgical Dressings LCD and related Policy Article at http://www.cgsmedicare.com/jc/coverage/LCDinfo.html for additional guidance on the coverage, coding and documentation requirements.