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 76655-XX
JOBST® FarrowWrap® Lite 76650-XX (002)
JOBST® FarrowWrap® Lite Foot and Sock Kit 20-30 mmHg 76122-XX (002)
JOBST® FarrowWrap® Lite Footpiece 20-30 mmHG 76652-XX
JOBST® FarrowWrap® Lite Thighpiece 20-30 mmHg 76655-XX
JOBST® FarrowWrap® Classic Thighpiece 30-40 mmHg 76658-XX
JOBST® FarrowWrap® Strong Leg Piece 30-40 mmHg 76648-XX Liner 76666-21 SM -22 LG
JOBST® Relax
JOBST® Relax Custom Leg Sleeve ThighHigh Open Toe 15-20 mmHg With or Without Zipper
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 76122-00
JOBST® Relax Custom Legsleeve Knee High Open Toe 20-30 mmHg With or Without Zipper (002)
JOBST® Custom Relax Armsleeve 15-20 mmHg With or Without Zipper
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® Flat Knit Full Length Chap 40+ mmHg HCPCS Code A6561
JOBST® Custom Flat Knit Arm Sleeve HCPCS Code A6576
JOBST® Custom Flat Knit Thigh High 40+ mmHg
JOBST® Custom Flat Knit Thigh High 18-30 mmHg
JOBST® Custom Flat Knit Foot Cap
JOBST® Custom Warped Knit (JOBST® Custom Seamed)
JOBST® Custom Circular Knit (JOBST® Seamless Soft and Bellavar)
JOBST® Bellisse®
JOBST® Bella™
JOBST® RTW Phlebology
JOBST® Post Operative
Bandages
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