Compression Stocking Authorizations: Additional Pairs Allowed for Active Duty Service Members
Thursday, March 16, 2023
Last year, Health Net Federal Services, LLC (HNFS) revised its authorization process for compression stockings, which fall under the durable medical equipment (DME) benefit, to allow for additional pairs for active duty service members. We appreciate your cooperation in dispensing the number of units authorized, especially to active duty service members who will be deploying or are deployed and need the additional pairs while away from home.
For compression stockings that meet criteria, approvals are limited to:
- Non-active duty service members – two pairs (4 units) per 12-month period
- Active duty service members – 12 pairs (24 units) per 12-month period
Per TRICARE policy, HNFS will authorize coverage of compression stockings prescribed for therapeutic treatment when the minimum pressure of the stockings is 20 mmHg or higher. Compression stockings with pressures below 20 mmHg are not considered to be of medical grade and therefore, do not meet the criteria for DME coverage, per TRICARE Policy Manual Chapter 8, Section 2.1, paragraph 2.2.
Please be sure to indicate the compression strength required on all compression stockings authorization requests.
Current medical industry coding guidelines list compression stockings in three different pressure ranges and four distinct size lengths.
- Pressure ranges: 18-30 mmHg, 30-40mmHg, 40-50mmHg
- Size lengths: below knee, thigh length, full length/chap style, or waist length
Since the minimal pressure of 20mmHg falls within the first pressure range of 18-30 mmHg, HNFS will pend all requests for A6530 (18-30 below knee), A6533 (18-30 thigh length), A6536 (18-30 full length/chap style), and A6539 (18-30 waist length) for manual review, as we will be unable to determine coverage based on coding.