Does A6520 require prior authorization?

Yes, A6520 requires prior authorization (high confidence). At least one active policy explicitly requires prior authorization.

What is the Medicare reimbursement rate for A6520?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.00.

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`A6520`, Gradient compression garment, glove, padded, for nighttime use, each

HCPCS/CPT

Prior Authorization

Prior Auth Required

At least one active policy explicitly requires prior authorization (high confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

This text is a background/evidence review summarizing clinical studies; it does not list 'Documentation Requirements' such as required medical records, test results, or specific clinical notes.
Diagnosis of CRPS should be based on the clinical features as determined by history and physical exam using the Budapest Criteria.

- Patient must report at least one symptom in each of the following four categories: Sensory (hyperesthesia and/or allodynia); Vasomotor (temperature asymmetry and/or skin color changes/asymmetry); Sudomotor/edema (edema and/or sweating changes/asymmetry); Motor/trophic (decreased range of motion and/or motor dysfunction such as weakness, tremor, dystonia and/or trophic changes in hair, nail, skin).

- At time of evaluation the patient must display at least one sign in two or more of these categories: Sensory (hyperalgesia to pinprick and/or allodynia to light touch/temperature/deep pressure/joint movement); Vasomotor (temperature asymmetry > 1 °C and/or skin color changes/asymmetry); Sudomotor/edema (edema and/or sweating changes/asymmetry); Motor/trophic (decreased range of motion and/or motor dysfunction/trophic changes).

Key Coverage Criteria

Combined transcranial direct current stimulation (tDCS) and transcutaneous electrical nerve stimulation (TENS) for chronic CRPS (single-case report: left lower limb CRPS type I).
It is not considered medically necessary to repeat sympathetic blocks more frequently than once every 7 days;
Continuous epidural analgesia for the treatment of members with intractable CRPS / RSD, when all of the following selection criteria are met: Members have experienced pain for more than 3 months despite conservative therapy (e.g., exercises, physical modalities and medications); and Members have failed a trial of physical therapy; and Members have failed a trial of nerve blocks with local anesthetics and steroids;
Sympathetic blocks (e.g., stellate ganglion block [cervical sympathetic block] and lumbar sympathetic block) for the diagnosis and treatment of sympathetically-maintained pain and/or CRPS when conservative treatments, including analgesia and physical therapy (PT), have failed.
Up to 3 sympathetic blocks are considered medically necessary to diagnose a member's pain and achieve a therapeutic effect; if the member experiences no pain relief after 3 injections, additional injections are not considered medically necessary.
Repeat sympathetic blocks for CRPS beyond the first 3 injections are considered medically necessary when provided as part of a comprehensive pain management program, which includes PT, patient education, psychosocial support, and oral medications, where appropriate.

2 Active Policies

EVICORE-HPLAN-CIGNA_MEDICARE-268F28B96146, Cigna Medicare Advantage Durable Medical Equipment Code List - Effective 01/01/2025

AETNA-CPB-0447, Complex Regional Pain Syndrome (CRPS): Treatments

`A6520`, Gradient compression garment, glove, padded, for nighttime use, each

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

2 Active Policies

Related Codes

Have a follow-up question?

A6520, Gradient compression garment, glove, padded, for nighttime use, each

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

2 Active Policies

Related Codes

Have a follow-up question?

`A6520`, Gradient compression garment, glove, padded, for nighttime use, each