HCPCS A6554 is officially defined as "Gradient compression stocking, below knee, 40 mmhg or greater, each." HCPCS A6554 is referenced in 5 tracked payer policy changes from Missouri Medicaid (MO HealthNet) and CareSource. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for HCPCS A6554 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
Effective June 1, 2026, MO HealthNet DME coverage for compression hose changes: adult patients (21+) with qualifying lymphedema diagnoses (ICD-10: I87.2, I89.0, I97.2, M79.6) now have automatic purchase-only coverage; most compression hose codes transition from manually priced (MP) to fixed maximum allowable amounts with invoice cost requirements removed; codes A6519 and A6549 remain manually priced.
Missouri MO HealthNet (Medicaid fee-for-service) revised its compression hose coverage for durable medical equipment. Effective June 1, 2026, adults aged 21 and older are covered for listed compression garments as purchase-only items only with a qualifying lymphedema diagnosis, and most listed garments move from manual pricing to set maximum allowable amounts. The bulletin was posted October 26, 2026, after its June 1 effective date, so the changes already apply to dates of service from June 1, 2026 onward.
CareSource is implementing enhanced claims editing for lymphedema compression treatment items (HCPCS codes A6520-A6610) effective May 4, 2026. Billing teams must ensure appropriate lymphedema diagnosis codes are used and apply right side (RT) or left side (LT) modifiers for bilateral claims, as the payer will now enforce stricter validation on these claims.
CareSource is enhancing claims editing for lymphedema compression treatment items (HCPCS codes A6520-A6610) effective February 24, 2026. Billing teams must now include appropriate lymphedema diagnoses and use RT (right side) or LT (left side) modifiers to indicate treatment laterality for bilateral claims.
Beginning January 15, 2026, CareSource will enhance claims editing for lymphedema compression treatment items (HCPCS codes A6520-A6610) to require appropriate lymphedema diagnosis codes and mandatory RT/LT modifiers to indicate treatment side (right or left). Bilateral billing is now permitted with proper modifier usage.
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