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® Lite

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® Trim-to-fit Foot Piece

JOBST® FarrowWrap® Lite Thighpiece 20-30 mmHg

JOBST® FarrowWrap® Lite Trim-to-fit Arm Piece 20-30 mmHg

JOBST® FarrowWrap® Lite Trim-to-fit Leg Piece 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® Lite Trim-to-fit Foot Piece

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® Strong Trim-to-fit Foot Piece 30-40 mmHg

JOBST® FarrowWrap® Strong Trim-to-fit Leg 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® FarrowWrap® Liners

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 Trunk

JOBST® JoViPak® Custom Upper Body Bra

JOBST® JoViLiner Arm

JOBST® JoViPak® Arm Sleeve RTW

JOBST® JoViPak® Head and Neck

JOBST® JoViPak® JoViLiner Leg

JOBST® JoViPak® Lower Leg

JOBST® JoViPak® Custom Arm Sleeve and Custom Glove

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 Flat Knit Compression Glove

JOBST® Custom Flat Knit Genital

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 Warped Knit Waist Length 30-40 mmHg

JOBST® Custom Warped Knit Waist Length 40+ 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® Custom Circular Knit Waist High 30-40 mmHg

JOBST® Custom Circular Knit Waist High

JOBST® Bellisse®

JOBST® Bellisse® Bra

JOBST® Bella™

JOBST® Bella™ Lite Arm Sleeves

JOBST® Bella™ Lite Arm Sleeves and Gauntlets (Combined)

JOBST® Bella™ Lite Gauntlets

JOBST® Bella™ Lite Gloves

JOBST® Bella™ Strong Armsleeves

JOBST® Bella™ Strong Gauntlet

JOBST® Bella™ Strong Gloves

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® Ulcer Care 2-in-1

JOBST® Opaque Waist High Closed Toe 15-20 mmHg

JOBST® Sport Sock 18-30 mmHg

JOBST® Post Operative

JOBST® Plastic Surgery Girdle

JOBST® Surgical Vests

JOBST® Epstein Facioplasty Support for Neck and Chin

JOBST® Epstein Facioplasty Support for Ears, Cheek and Chin

Bandages

JOBST® Artiflex

JOBST® Isoband

JOBST® Comprifoam

JOBST® Comprilan Short Stretch Compression Bandage

JOBST® Tricofix Lightweight Stockinette

JOBST® Foam Pad

JOBST® Compri2 and Compri2 Lite

JOBST® Elastomull

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® JoViPads

JOBST® Metal Donner Accessories

JOBST® Stocking Slips

JOBST® Ulcer Liners

JOBST® Confidence Custom Flat Knit Accessories

Arion Easy Slide

Arion Easy Slide Arm

Arion Magnide 2 in 1 Accessories

Arion Magnide Accessories

Arion Proth-Pro

Arion Sim Slide

Arion Slidex

 

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