The following table indicates claims submission requirements for compression garments. When submitting claims for HCPCS procedure codes A6530 to A6549 and S8420 to S8429, providers are required to include on or with the claim all of the checked information in the table that corresponds to the procedure code on the claim. A blank cell indicates that the requirement does not apply to the corresponding procedure code.
| Procedure Code | ICD-9-CM* Diagnosis Code | RT and/or LT Modifier Required? | Include Copy of Order Form That Includes Measurements Taken |
Include Copy of Manufacturer's Invoice | Include Copy of Physician's Prescription |
| A6530 |
X |
Yes | |||
| A6531 |
X |
Yes | |||
| A6532 |
X |
Yes | |||
| A6533 |
X |
Yes | |||
| A6534 |
X |
Yes | |||
| A6535 |
X |
Yes | |||
| A6536 |
X |
Yes | |||
| A6537 |
X |
Yes | |||
| A6538 |
X |
Yes | |||
| A6539 |
X |
||||
| A6540 |
X |
||||
| A6541 |
X |
||||
| A6549 |
X |
Yes |
X |
X |
X |
| S8420 |
X |
Yes |
X |
X |
X |
| S8421 |
X |
Yes | |||
| S8422 |
X |
Yes |
X |
X |
X |
| S8423 |
X |
Yes |
X |
X |
X |
| S8424 |
X |
Yes | |||
| S8425 |
X |
Yes |
X |
X |
X |
| S8426 |
X |
Yes |
X |
X |
X |
| S8427 |
X |
Yes | |||
| S8428 |
X |
Yes | |||
| S8429 |
X |
Yes |
X |
X |
X |
*International Classification of Diseases, Ninth Revision, Clinical Modification
Providers are required to include modifier "RT" and/or "LT" on claims submitted for procedure codes A6530 to A6538, A6549, and S8420 to S8429. Modifier "RT" is used to reference a garment applied to a right extremity. Modifier "LT" is used to reference a garment applied to a left extremity. Procedure codes A6530 to A6538, A6549, and S8420 to S8429 are incomplete without modifier "RT" or "LT."
If there is a bilateral need, providers are required to submit two separate details on claims, with modifier "RT" on one detail and modifier "LT" on a second detail. ForwardHealth will not accept modifier "50" (Bilateral) for processing claims for compression garments.