Surgical Dressings have been assigned specific HCPCS codes starting with the letter “A”. For Example, A6545 – Gradient Compression Wrap. AMERX Surgical Dressings have unique assigned codes that can be found on their specific product page. A full list of assigned codes can also be found at: www.dmePDAC.com
For a full list of HCPCS Codes assigned to AMERX Surgical Dressings, download the latest copy of AMERX Health Care’s HCPCS Coding Guidance today!
Yes. PDAC assigned EXTREMIT-EASE Compression Garment HCPCS Code A6545.
Surgical Dressing require the use of an “A” modifier to designate the number of wounds diagnosed when billing insurance. “A1” represents 1 wound, “A2” represents 2 wounds and so forth.
When using Compression Therapy in conjunction with the topical dressing, Modifier AW with RT or LT must be used to designate location. Modifiers AW (Associated With) designates the use of the products together with the topical dressing and RT (Right) or LT (Left) designates which limb the products are prescribed. Download the latest HCPCS Coding Guidance booklet from AMERX to learn more.
The garment liner included with the EXTREMIT-EASE Compression Garment provides 10-15 mmHg of compression to the foot and 3-5 mmHg of compression to the leg.
If the dressings are sent home or delivered to the patient’s home for use, the Place of Service (POS) should be 12 – Home. Download the latest AMERX HCPCS Coding Guidance to learn more.
The design of the EXTREMIT-EASE Compression Garment includes a white line sewn into the side of the garment and a white and red line sewn into the tabs. When applying the product, how much compression is achieved is determined by where the white line sewn into the garment correlates to the white and red line sewn into the tabs. For lower, 30 mmHg, align the white line sewn into the garment with the white line sewn into the tab. To achieve higher compression, 50 mmHg, continue pulling the tabs so the red line sewn into the tab lines up with the white line sewn into the garment.
Units of Measure are based on the primary dressing chosen and the frequency of dressing changes.
When billing for AMERX Wound Care Kits, the kit itself does not have an assigned code and as such, each individual item within the kit must be billed using the proper code. For Example, a 30-day Collagen Wound Care Kit, containing 30 units of primary dressing (Collagen), 30 units of Secondary Dressings (Bordered Gauze), and 30 units of Supportive Dressing (2×2 Gauze Pads) would be billed with the following units of measure, 30-A6010, 30–A6219 and 30-A6216.
This can be confusing with Hydrogel Dressings (HCPCS Code – A6248) because the Unit of measure for the primary dressing (hydrogel) is based on ounces, not individual pads. As such, the unit of measure becomes the number of ounces prescribed for the treatment period.
EXTREMIT-EASE is now eligible for continued benefits under the LTA. Medicare’s LTA policy states patients are eligible for a new set of garments every 6 months for up to 3 garments and their accompanying liners.
You must contact the insurance provider to find out their policies.
Proof of Delivery is a receipt detailing the Surgical Dressings provided to the patient. When dispensing directly to the patient, the patient must sign the POD acknowledging they have received the items prescribed by their physician.
The indications are: The Management of mild-to-moderate swelling from lymphedema, chronic venous insufficiency, acute post-operative edema, and other swelling disorders.
Yes, all DME items require a Proof of Delivery (POD) on file and stored in the patient records.
Medicare’s LTA policy states patients are eligible for a new set of garments every 6 months for up to 3 garments and their accompanying liners.
Yes. When dispensing DME Wound Care Supplies, the prescribing physician must document the necessity for supplies. This typically will be established through the Wound Debridement or Surgical Procedure documentation. Once this has been established, the prescribing physician must also document the product prescribed, the amount of product prescribed, the frequency of dressing changes, and the treatment plan/goal.
The garment liners are based primarily on foot size. 
Ask for input! It’s always best to involve your team in the dispensing protocols. Seeking input from your team will help establish a better understanding of where potential errors or bottlenecks will arise so the team can best determine how and who is responsible for these tasks. Empowering your team will allow the physicians to focus more time on the patient’s care.
To find the proper size garment, you must be able to measure the calf, ankle, and distance from the floor to the bony prominence below the knee. CLICK HERE to see a video on proper sizing or view below for the EXTREMIT-EASE Measurement Guide.
An ABN form is necessary when the prescribing physician is unsure if the item is covered by insurance and allows the patients to make a more informed decision. In the case of Surgical Dressings, as long as the procedure and wound characteristics meet the requirements, the Surgical Dressing will be covered if properly billed.
During the initial use of the product, the materials are NEW, flat, and can be stiff. Over time, the materials will soften and begin to take the shape of the patients’ limb. The following are recommended to minimize any challenges with applying the garment:
-
- 1) Ensure all tabs have been released from the garment prior to application. If only the tabs that cover the zipper are released, this will prevent the garment from expanding to its fullest capacity.
- 2) Stretch the opening: Once the tabs have been removed, you can place your arms inside the garment and expand the garment’s circumference. This will help ensure you have reached the full capacity prior to application.
- 3) Wash the garment: The NEW product is stiff from the manufacturing process. Washing the garment will soften the fabric and allow for easier application.
Yes. PDAC has assigned reimbursement rates to all Surgical Dressings assigned with HCPCS code. Coverage of these items requires PDAC approval. AMERX products are PDAC-approved, and the Fee Schedule determines the reimbursement rate. When you work with AMERX Health Care, you have access to our regularly updated HCPCS Coding Guidance to be sure you have the most up-to-date reimbursement information available for AMREX products. HCPCS Codes and Fee Schedules can be found at www.dmePDAC.com.
CPT 97597 is fine for EXTREMIT-EASE and 11042 is not necessary. In the surgical dressing LCD and LCA, a thickness requirement for compression garments is not noted. So all you need is:
- Medical necessity (edema/stasis)
- An ulcer that was debrided or caused by a surgical procedure
- Drainage documented
A collagen-based dressing or wound filler is covered for full-thickness wounds (e.g., stage III or IV ulcers); wounds with light to moderate exudate; or wounds that have stalled or have not progressed toward a healing goal.
Every wound is unique and requires various treatment options for successful outcomes. AMREX has created a Wound Guide to help with these decisions. It is recommended to have multiple options in your practice to address the various wound types. Here is a link to Dr. Lehrman’s webinar on selecting the proper dressings for each wound: Compliance With Combining Primary and Secondary Dressings
AMERX Wound Care Kits are pre-bundled in 30-Day, 15-Day, and 5-Day kits that include Primary, Secondary, and Supportive Dressings as well as Saline Wound Wash to cleanse the wound between dressing changes. CLICK HERE to learn about AMERX Wound Care Kit options available today!
View our video library for instructional videos that will walk you through how to use our HELIX3-Bioactive Collagen:
Yes. AMERX has a variety of videos to choose from and continues to add new options to the video library. If you do not see what you are looking for, please let us know by CLICKING HERE.
No. Surgical Dressings are not included in the same or similar policy.
