This page is dedicated to host the PDAC approval letters for the JOBST® compression garments in conjunction with the Lymphedema Treatment Act new HCPCS Codes.
JOBST® FarrowWrap®
JOBST® FarrowWrap® Lite Thighpiece 20-30 mmHg
JOBST® FarrowWrap® Basic Leg Piece 30-40 mmHg
JOBST® FarrowWrap® Lite Leg Piece 20-30 mmHg
JOBST® FarrowWrap® Lite Knee Piece 20-30 mmHg
JOBST® FarrowWrap® Lite Custom Thigh Piece 20-30 mmHg with Knee Piece
JOBST® FarrowWrap® Lite Hand Gauntlet 20-30 mmHg
JOBST® FarrowWrap® Trim-to-fit Extra Band Velcro Pack
JOBST® FarrowWrap® Lite Foot and Sock Kit 20-30 mmHg
JOBST® FarrowWrap® Lite Footpiece 20-30 mmHG
JOBST® FarrowWrap® Lite Thighpiece 20-30 mmHg
JOBST® FarrowWrap® Lite Custom Arm Piece 20-30 mmHg with Arm Liners
JOBST® FarrowWrap® Lite Custom Foot Piece 20-30 mmHg
JOBST® FarrowWrap® Lite Custom Leg Piece 20-30 mmHg with Standard Liners
JOBST® FarrowWrap® Classic Thighpiece 30-40 mmHg
JOBST® FarrowWrap® Classic Custom Arm Piece 30-40 mmHg with Arm Liners
JOBST® FarrowWrap® Classic Custom Leg Piece 30-40 mmHg
JOBST® FarrowWrap® Classic Custom Foot Piece 30-40 mmHg
JOBST® FarrowWrap® Classic Footpiece 30-40 mmHg
JOBST® FarrowWrap® Strong Custom Arm Piece 30-40 mmHg with Arm Liners
JOBST® FarrowWrap® Strong Custom Foot Piece 30-40 mmHg
JOBST® FarrowWrap® Strong Custom Leg Piece 30-40 mmHg with Standard Liners
JOBST® FarrowWrap® Strong Knee Piece 30-40 mmHg
JOBST® FarrowWrap® Strong Thigh Piece Combination 30-40 mmHg
JOBST® FarrowWrap® Strong Custom Thigh Piece with Knee Piece 30-40 mmHg
JOBST® FarrowWrap® Strong Leg Piece 30-40 mmHg
JOBST® FarrowWrap® Strong Foot Piece 30-40 mmHg
JOBST® FarrowWrap® Classic Leg Piece 30-40 mmHg
JOBST® FarrowWrap® 4000 30-40mmHg
JOBST® FarrowWrap® Ready-to-Wear Glove 15-20 mmHg
JOBST® FarrowWrap® Ready-to-Wear Glove 20-30 mmHg
JOBST® FarrowWrap® Ready-to-Wear Toe Cap 20-30 mmHg
JOBST® FarrowHybrid® ADI and ADIW Foot Compression FarrowLiner™
JOBST® FarrowWrap® Classic Custom Thigh Piece 30-40 mmHg with Knee Piece
JOBST® Relax
JOBST® Custom Relax Arm Sleeve with Gauntlet 15-20 mmHG With or Without Zipper
JOBST® Custom Relax Legsleeve Knee High Open Toe 15-20 mmHg W or WO Zipper
JOBST® Custom Relax Legsleeve Thigh High Open Toe 20-30 mmHg With or Without Zipper
JOBST® Relax Custom Legsleeve Knee High Open Toe 20-30 mmHg With or Without Zipper
JOBST® Relax Custom Legsleeve Thigh High Open Toe 15-20 mmHg With or Without Zipper
JOBST® Custom Relax Armsleeve 15-20 mmHg With or Without Zipper
JOBST® JoviPak®
JOBST® JoViPak® Custom Lower Leg
JOBST® JoViPak® Custom Full Leg
JOBST® JoViPak® Custom Upper Body Bra
JOBST® Custom Flat Knit (JOBST® Elvarex®, Elvarex® Plus, Elvarex® Soft, Elvarex® Soft Seamless, and Confidence)
JOBST® Custom Flat Knit Full Length Chap 18-30 mmHg
JOBST® Custom Flat Knit Full Length Chap 30-40 mmHg
JOBST® Flat Knit Full Length Chap 40+ mmHg
JOBST® Custom Flat Knit Arm Sleeve
JOBST® Custom Flat Knit Arm Sleeves and Glove Combined
JOBST® Custom Flat Knit Thigh High 18-30 mmHg
JOBST® Custom Flat Knit Thigh High 30-40 mmHg
JOBST® Custom Flat Knit Thigh High 40+ mmHg
JOBST® Custom Flat Knit Foot Cap
JOBST® Custom Flat Knit Below Knee 40+ mmHg
JOBST® Custom Flat Knit Below Knee 18-30 mmHg
JOBST® Custom Flat Knit Below Knee 30-40 mmHg
JOBST® Custom Flat Knit Compression Gauntlets
JOBST® Custom Warped Knit (JOBST® Custom Seamed)
JOBST® Custom Seamed Warped Knit Mitten
JOBST® Custom Warped Knit Arm Sleeve and Glove
JOBST® Custom Warped Knit Arm Sleeves
JOBST® Custom Warped Knit Arm Stump Garment
JOBST® Custom Warped Knit Stump Above or Below Knee 18-30 mmHg
JOBST® Custom Warped Knit Stump Above or Below Knee 30-40 mmHg
JOBST® Custom Warped Knit Stump Above or Below Knee 40+ mmHg
JOBST® Custom Warped Knit Waist Length Stump Support 18-30 mmHg
JOBST® Custom Warped Knit Waist Length Stump Support 30-40 mmHg
JOBST® Custom Warped Knit Waist Length Stump Support 40+ mmHg
JOBST® Custom Warped Knit Below Knee 18-30 mmHg
JOBST® Custom Warped Knit Below Knee 30-40 mmHg
JOBST® Custom Warped Knit Below Knee 40+ mmHg
JOBST® Custom Warped Knit Body Brief and Body Suit
JOBST® Custom Warped Knit Foot Glove
JOBST® Custom Warped Knit Full Length Style, Chap 18-30 mmHg
JOBST® Custom Warped Knit Full Length Style, Chap 30-40 mmHg
JOBST® Custom Warped Knit Full Length Style, Chap 40+ mmHg
JOBST® Custom Warped Knit Gauntlet
JOBST® Custom Warped Knit Genital Garment
JOBST® Custom Warped Knit Thigh Length 18-30 mmHg
JOBST® Custom Warped Knit Thigh Length 30-40 mmHg
JOBST® Custom Warped Knit Thigh Length 40+ mmHg
JOBST® Custom Warped Knit Vest
JOBST® Custom Warped Knit Waist Length 18-30 mmHg
JOBST® Custom Circular Knit (JOBST® Seamless Soft and Bellavar)
JOBST® Custom Circular Knit Below Knee 18-30 mmHg
JOBST® Custom Circular Knit Below Knee 30-40 mmHg
JOBST® Custom Circular Knit Chaps 18-30 mmHg
JOBST® Custom Circular Knit Thigh High 18-30 mmHg
JOBST® Custom Circular Knit Thigh High
JOBST® Bellisse®
JOBST® Bella™
JOBST® Bella™ Lite Arm Sleeves
JOBST® Bella™ Lite Arm Sleeves and Gauntlets (Combined)
JOBST® RTW Phlebology
JOBST® Maternity Opaque Knee High 18-30 mmHg
JOBST® Maternity Opaque Thigh High 18-30 mmHg
JOBST® Maternity Opaque Waist High 18-30 mmHg
JOBST® Style Knee High 18-30 mmHg
JOBST® Style Knee High 30-40 mmHg
JOBST® forMen Thigh High 30-40 mmHg Open Toe
JOBST® forMen Thigh High 30-40 mmHg
JOBST® forMen Thigh High 18-30 mmHg
JOBST® forMen Knee High 30-40 mmHg Closed Toe
JOBST® forMen Knee High 30-40 mmHg OpenToe
JOBST® forMen Knee High 18-30 mmHg
JOBST® Opaque Knee High Open Toe – Closed Toe 15-20 mmHg
JOBST® Opaque Thigh High 15-20 mmHg
JOBST® Opaque Waist High, Closed Toe, Firm Compression Stockings 20-30 mmHg
JOBST® Opaque Knee High 20-30 mmHg
JOBST® Opaque Thigh High Open Toe – Closed Toe 30-40 mmHg
JOBST® Opaque Waist High Closed Toe Extra Firm Compression Stockings 30-40 mmHg
JOBST® Opaque Sensitive Thigh High Closed Toe Extra Firm Compression Stockings 30-40 mmHg
JOBST® Activewear Knee High 18-30 mmHg
JOBST® Activewear Knee High 30-40 mmHg
JOBST® Opaque Thigh High Open Toe – Closed Toe 20-30 mmHg
JOBST® Opaque Knee High Open Toe – Closed Toe 30-40 mmHg
JOBST® Opaque Softfit Knee High 30-40 mmHg
JOBST® Post Operative
Bandages
JOBST® Comprilan Short Stretch Compression Bandage
JOBST® Tricofix Lightweight Stockinette
Accessories
JOBST® Custom Flat Knit Accessories
JOBST® Custom Warped Knit Accessories
JOBST® Custom Circular Knit Accessories
JOBST® Donning Gloves Accessories
JOBST® JoVi Jacket Accessories
JOBST® JoViPak® Custom Accessories
JOBST® Metal Donner Accessories
JOBST® Confidence Custom Flat Knit Accessories
PDAC letters may have been modified by company to remove personal information of company personnel.
Please note: A HCPCS Code (Healthcare Common Procedure Coding System Codes) is never a guarantee of coverage or payment for any claim submitted for payment to any private and public insurance carrier.
If you need further information reach out to your JOBST® sales representative or visit https://www.cms.gov/medicare/payment/fee-schedules/dmepos-fee-schedule/lymphedema-compression-treatment-items.
The Centers for Medicare & Medicaid Services (CMS) uses Palmetto GBA as the Pricing, Data Analysis, and Coding (PDAC) Contractor. The PDAC Contractor maintains the Product Classification List, located at https://www4.palmettogba.com/pdac_dmecs. The Product Classification List is a searchable database containing products that have received HCPCS coding verification from PDAC and their corresponding HCPCS codes. BSN Medical Inc., however, makes no representations as to the accuracy of the information contained within the PDAC database, nor any representations as to whether its products are reimbursable under any government sponsored healthcare program and/or private-insurance program. It is the provider’s sole responsibility, in consultation with the insurer, if necessary, to determine medical necessity, ensure coverage criteria is met, and submit appropriate codes, modifiers, and charges for services rendered. RV: 12/23