Guideline Updates Reimbursement PoliciesHealthKeepers, Inc. | Anthem HealthKeepers Plus Medicaid productsJuly 21, 2023

Change to DME elastic support items

Please note, this communication applies to Anthem HealthKeepers Plus Medicaid products offered by HealthKeepers, Inc.

Effective October 1, 2023, HealthKeepers, Inc. will align the benefit limits for elastic support items with Virginia Department of Medical Assistance Services (DMAS) benefit limits. The affected codes are listed below. This change will affect the current reimbursement policy and related claims processing rules associated with the listed codes.

HealthKeepers, Inc. will no longer reimburse for any amount that exceeds the DMAS benefit limits for Anthem HealthKeepers Plus members.

HealthKeepers, Inc. will only reimburse providers for quantities exceeding DMAS limits when prescribed by a physician, documented on a Certificate of Medical Necessity (CMN), and authorized by HealthKeepers, Inc. HealthKeepers, Inc. follows the same criteria as DMAS in determining all medical necessity approval.

We recommend that providers visit the online provider manual to review all authorization, appeals, and reconsideration processes.

Code

Description

Billing unit

DMAS limit

A4490

Surgical stockings, above knee length, each

Each

2/6 months

A4495

Surgical stockings, thigh length, each

Each

2/6 months

A4500

Surgical stockings, below knee length, each

Each

2/6 months

A4510

Surgical stocking full-length, each

Each

2/6 months

A6530

Gradient compression stocking, below knee, 
 18-30 mmHg, each

Each

2/6 months

A6531

Gradient compression stocking, below knee, 
 30-40 mmHg, each

Each

2/6 months

A6532

Gradient compression stocking, below knee, 
 40-50 mmHg, each

Each

2/6 months

A6533

Gradient compression stocking, thigh length, 
 18-30 mmHg, each

Each

2/6 months

A6534

Gradient compression stocking, thigh length, 
 30-40 mmHg, each

Each

2/6 months

A6535

Gradient compression stocking, thigh length, 
 40-50 mmHg, each

Each

2/6 months

A6536

Gradient compression stocking, full length/chap style, 18-30 mmHg, each

Each

2/6 months

A6537

Gradient compression stocking, full length/chap style, 30-40 mmHg, each

Each

2/6 months

Code

Description

Billing unit

DMAS limit

A6538

Gradient compression stocking, full length/chap style, 40-50 mmHg, each

Each

2/6 months

A6539

Gradient compression stocking, waist length, 
 18-30 mmHg, each

Each

2/6 months

A6540

Gradient compression stocking, waist length, 
 30-40 mmHg, each

Each

2/6 months

A6541

Gradient compression stocking, waist length, 
 40-50 mmHg, each

Each

2/6 months

A6544

Gradient compression stocking, garter belt

Each

2/6 months

A6545

Gradient compression wrap, non-elastic, below knee, 30-50 mmHg, each

Each

2/6 months

A6549

Gradient compression stocking, NOS

Each

2/6 months

If you have any questions about this communication, call Anthem HealthKeepers Plus Provider Services at 800-901-0020.

VABCBS-CD-028856-23