{"id":180314,"date":"2026-08-17T07:16:07","date_gmt":"2026-08-17T07:16:07","guid":{"rendered":"https:\/\/pabau.com\/?p=180314"},"modified":"2026-08-18T13:19:07","modified_gmt":"2026-08-18T13:19:07","slug":"hcpcs-code-a4490","status":"publish","type":"post","link":"https:\/\/pabau.com\/fr\/procedure-codes\/hcpcs-code-a4490\/","title":{"rendered":"HCPCS Code A4490: Surgical stockings above knee length"},"content":{"rendered":"\n<script type=\"application\/ld+json\">{\"@context\":\"https:\/\/schema.org\",\"@type\":\"MedicalWebPage\",\"headline\":\"HCPCS Code A4490: Surgical stockings above knee length, each\",\"description\":\"HCPCS code A4490 bills one above-knee surgical stocking. Medicare treats it as statutorily non-covered, so the claim runs on the GY modifier.\",\"url\":\"https:\/\/pabau.com\/procedure-codes\/hcpcs-code-a4490\/\",\"audience\":{\"@type\":\"MedicalAudience\",\"audienceType\":\"Clinician\"},\"reviewedBy\":{\"@type\":\"Person\",\"name\":\"Dr Vanja Kitanova\",\"jobTitle\":\"Medical Reviewer\",\"affiliation\":{\"@type\":\"Organization\",\"name\":\"Pabau\"},\"knowsAbout\":[\"Medical Coding\",\"Clinical Documentation\",\"Healthcare Billing\",\"Clinical Safety\"],\"sameAs\":\"https:\/\/pabau.com\/blog\/author\/vanja\/\"},\"datePublished\":\"2026-08-12\",\"dateModified\":\"2026-08-17\"}<\/script>\n\n\n        <div id=\"key_takeaways\">\n            <div class=\"header\">\n                                    <img decoding=\"async\" src=\"https:\/\/pabau.com\/wp-content\/uploads\/2025\/12\/Key-Takeaways-Icon.svg\" alt=\"Key takeaways\" height=\"42\" width=\"42\">\n                                <h3>Key takeaways<\/h3>\n            <\/div>\n            <div class=\"list\">\n                                                            <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>HCPCS code A4490 bills one above-knee surgical stocking, and each stocking counts as a single unit of service.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>Medicare does not cover A4490. CMS lists surgical stockings as non-covered under the surgical dressing benefit.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>Report the GY modifier to produce the formal Medicare denial that a secondary payer needs before it pays.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>A4490 covers above-knee length only. Thigh-length stockings bill under A4495, and mixing the two triggers denials.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>Practice management software like Pabau keeps the order, the delivery receipt, and the claim in one patient record.<\/p>\n                        <\/div>\n                                                <\/div>\n        <\/div>\n    \n\n\n<p class=\"wp-block-paragraph\">HCPCS code A4490 is the Level II supply code for one above-knee surgical stocking. The descriptor reads \u00ab\u00a0Surgical stockings above knee length, each\u00a0\u00bb, so one stocking equals one unit. DME suppliers bill it under a written physician order, often for venous insufficiency or post-surgical edema.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">One detail changes how the whole claim is handled. Medicare treats A4490 as statutorily non-covered, which moves the work away from the coverage-criteria checklist used for payable DME. This reference covers the descriptor, Medicare&rsquo;s position, the modifiers that apply, unit reporting, and the codes billers confuse with A4490.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">HCPCS code A4490: Definition and official descriptor<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">A4490 belongs to the A-series of the <a href=\"https:\/\/www.cms.gov\/medicare\/coding-billing\/healthcare-common-procedure-system\" target=\"_blank\" rel=\"nofollow noopener\">HCPCS<\/a> Level II code set. The Centers for Medicare and Medicaid Services (CMS) maintains that set for supplies and durable medical equipment, or DME.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Field<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Details<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Code<\/td>\n<td style=\"padding:12px 16px;color:#374151\">A4490<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Short description<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Surgical stocking above knee length<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Long description<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Surgical stockings above knee length, each<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Code type<\/td>\n<td style=\"padding:12px 16px;color:#374151\">HCPCS Level II<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Category<\/td>\n<td style=\"padding:12px 16px;color:#374151\">A-series medical supplies<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Unit of service<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Each, meaning one stocking per unit<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Claim jurisdiction<\/td>\n<td style=\"padding:12px 16px;color:#374151\">DME MAC<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Medicare status<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Non-covered under the surgical dressing benefit<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Code status<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Active<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">The \u00ab\u00a0each\u00a0\u00bb descriptor decides your unit count. One stocking equals one unit. Billing a pair on one line without raising the unit count is a routine error, and DME MAC edits catch it. Claims management software can hold quantity rules that flag it before submission.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/cdn.pabau.com\/cdn\/attachments\/pulse\/content-engine\/billing_codes\/hcpcs-code-a4490\/track-claims-from-start-to-finish.webp\" alt=\"Track claims from start to finish\"\/><figcaption class=\"wp-element-caption\"><em>Pabau&rsquo;s claims management tracks every supply claim from the physician order through to payment, so nothing stalls unnoticed.<\/em><\/figcaption><\/figure>\n\n\n\n<div style=\"height:35px;width:800px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<h2 class=\"wp-block-heading\">Medicare coverage: Why A4490 is non-covered<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Medicare does not pay for A4490. The CMS <a href=\"https:\/\/www.cms.gov\/medicare-coverage-database\/view\/article.aspx?articleId=54563\" target=\"_blank\" rel=\"nofollow noopener\">Surgical Dressings policy article<\/a> lists surgical stockings A4490 through A4510 as non-covered under the surgical dressing benefit. Claims are denied as statutorily non-covered, with no benefit category.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">That verdict does not depend on the patient&rsquo;s diagnosis or the strength of the order. Here is what it changes in practice.<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li><strong>No LCD pathway:<\/strong> A statutory exclusion sits outside Local Coverage Determination criteria. There is no documentation set that turns an A4490 claim into a paid one.<\/li><li><strong>Jurisdiction stays with the DME MAC:<\/strong> A4490 sits on the DMEPOS jurisdiction list. The denial comes from the DME MAC, not the local carrier.<\/li><li><strong>An ABN is optional here:<\/strong> Medicare does not require an Advance Beneficiary Notice for statutorily excluded items. Many suppliers still issue one so the patient sees the cost in writing.<\/li><li><strong>Other payers may cover:<\/strong> Medicaid programs and commercial policies set their own rules for surgical and compression stockings. Verify benefits and prior authorization before dispensing.<\/li><li><strong>Submit only when a denial is needed:<\/strong> Bill Medicare when a secondary payer wants a formal denial first, and append GY.<\/li><\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Payment rules for supplies live in Medicare&rsquo;s own fee schedule, not the physician fee schedule that covers CPT services. Check the <a href=\"https:\/\/www.cms.gov\/medicare\/payment\/fee-schedules\/dmepos\/dmepos-fee-schedule\" target=\"_blank\" rel=\"nofollow noopener\">DMEPOS fee schedule<\/a> or your DME MAC&rsquo;s lookup tool to confirm what Medicare pays for any supply code.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Plan type is worth checking before you write the patient off as self-pay. Some Medicare Advantage plans add supplemental benefits that original Medicare does not offer, so <a href=\"https:\/\/pabau.com\/blog\/medicare-billing\/\">Medicare billing<\/a> rules can differ by plan. Medicaid and commercial coverage varies by state and contract.<\/p>\n\n\n        <div id=\"pro_tip\">\n            <div class=\"img\">\n                <svg width=\"42\" height=\"42\" viewBox=\"0 0 42 42\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M12.6383 19.5238C12.6632 21.2071 12.8734 22.9926 12.0685 24.5523C11.0341 26.8917 8.45076 28.169 7.56292 30.5918C6.63082 33.1061 7.19505 36.185 9.31371 37.9786C10.929 39.5678 13.4183 39.9873 15.6061 39.5463C17.4592 39.073 19.1049 37.8388 19.9706 36.1608C20.781 34.7141 20.7866 32.9904 20.5293 31.3985C20.1006 29.3092 18.3775 27.8705 16.9807 26.362C14.8814 24.1005 14.6684 20.6854 15.595 17.8915C16.4331 15.4768 19.0026 14.2344 20.0425 11.9461C20.7202 10.6769 20.7506 9.20327 20.6068 7.81304C20.1864 5.40098 18.3139 3.23631 15.8716 2.56674C13.9742 2.03969 11.8224 2.30052 10.1739 3.37614C8.70522 4.34688 7.5878 5.86618 7.28356 7.58178C6.76081 9.82981 7.53525 12.2822 9.20307 13.9118C10.7658 15.4741 12.4806 17.2273 12.6383 19.5238Z\"\n                        fill=\"#2BADD4\" \/>\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M22.7048 19.8387C22.6822 22.3279 24.4507 24.6234 26.7493 25.4682C28.0531 25.961 29.4725 25.9183 30.7989 25.5487C32.0575 24.9955 33.301 24.2237 34.0069 23.0092C34.8384 21.5811 35.2982 19.8286 34.7832 18.2094C34.3611 16.2507 32.8739 14.6541 31.0275 13.9426C28.6736 12.9595 25.8073 13.7942 24.1719 15.7001C23.2022 16.8366 22.6143 18.3326 22.7048 19.8387Z\"\n                        fill=\"#2BADD4\" \/>\n                <\/svg>\n            <\/div>\n            <div class=\"text\">\n                <h3>Pro Tip<\/h3>\n                <p>Bill A4490 to Medicare only when the patient&rsquo;s secondary payer needs a formal denial on file. Append GY, and add GX if you issued a voluntary ABN. Sending the claim without GY invites a different denial reason and a slower appeal.<\/p>\n            <\/div>\n        <\/div>\n    \n\n\n<h2 class=\"wp-block-heading\">Modifiers that apply to A4490<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Modifiers tell the payer the circumstances of the supply. On a statutorily excluded item they also tell Medicare that you expect the denial and why you filed anyway. Confirm current requirements with your DME MAC before appending anything.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Modifier<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Description<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">When to apply<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">RT<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Right side<\/td>\n<td style=\"padding:12px 16px;color:#374151\">The stocking was dispensed for the right leg.<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">LT<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Left side<\/td>\n<td style=\"padding:12px 16px;color:#374151\">The stocking was dispensed for the left leg.<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">GY<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Item statutorily excluded, no Medicare benefit<\/td>\n<td style=\"padding:12px 16px;color:#374151\">The usual pairing for A4490, filed to produce a denial a secondary payer can read.<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">GX<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Notice of liability issued voluntarily<\/td>\n<td style=\"padding:12px 16px;color:#374151\">An ABN was issued even though Medicare does not require one here.<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">KX<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Coverage criteria in the medical policy are met<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Not used on A4490, since a statutory exclusion has no criteria to meet.<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">GA<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Waiver of liability on file as payer policy requires<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Reserved for items where an ABN is mandatory, so GX fits A4490 better.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">GY does most of the work here. It produces a clean statutory denial, which is what a supplemental or commercial secondary plan wants to see before it pays. Add RT or LT on the same line so the payer can tell the two legs apart.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Billing guidelines and claim submission<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Correct coding is one step of several. Claim preparation, documentation, and unit reporting all decide whether the claim resolves on first submission. The steps below reflect standard DME supply practice, so confirm details with the payer you are billing.<\/p>\n\n\n\n<ol class=\"wp-block-list\"><li><strong>Confirm the order before dispensing.<\/strong> Document the physician order with the diagnosis, the stocking type, the affected limb, and the prescriber&rsquo;s signature and date.<\/li><li><strong>Identify the payer of record.<\/strong> Check the portal or call to confirm whether the plan covers surgical stockings and whether prior authorization applies. Some commercial plans require it for supplies.<\/li><li><strong>Select the correct length code.<\/strong> Use A4490 for above-knee stockings only. Thigh-length stockings bill under A4495, and the surgical stocking family runs through A4510.<\/li><li><strong>Report units correctly.<\/strong> Each stocking is one unit. A bilateral fitting is two units, or two lines carrying RT and LT, depending on payer preference.<\/li><li><strong>Append the right modifiers.<\/strong> Add RT or LT for laterality. Add GY on Medicare claims, plus GX when you issued a voluntary ABN.<\/li><li><strong>Attach supporting ICD-10-CM codes.<\/strong> The diagnosis must match the condition in the physician order. A mismatch between order and claim is an immediate denial trigger.<\/li><\/ol>\n\n\n\n<p class=\"wp-block-paragraph\">Retention is the other half of the job. CMS and the DME MACs expect suppliers to keep documentation for at least seven years from the date of service. Practices that pair patient records with <a href=\"https:\/\/pabau.com\/blog\/medical-forms-at-your-healthcare-practice\/\">structured documentation workflows<\/a> can produce a complete file quickly during a post-payment review.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">That matters most for teams dispensing supplies alongside treatment. <a href=\"https:\/\/pabau.com\/blog\/practice-management-software\/\">Practice management software<\/a> that holds billing and documentation together cuts the manual work of staying audit-ready. Podiatry teams fitting stockings after nail or wound procedures get the same benefit from <a href=\"https:\/\/pabau.com\/industry\/lp\/podiatry-software\/\">podiatry software<\/a>.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">How to document medical necessity<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Documentation still matters once Medicare is out of the picture. Commercial plans, Medicaid programs, and secondary payers all ask for the same core file. Below is what the patient record should hold before the claim goes out.<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li><strong>Written physician order:<\/strong> Include the patient&rsquo;s name, the order date, the item described as an above-knee surgical stocking, quantity, prescriber name, NPI, signature, and diagnosis.<\/li><li><strong>Clinical support for the diagnosis:<\/strong> The record needs findings that justify the prescription. For venous conditions that usually means duplex ultrasound results or a documented assessment of chronic venous insufficiency.<\/li><li><strong>Benefit verification:<\/strong> Record the date and result of the eligibility check, including the payer&rsquo;s coverage response and any prior authorization number.<\/li><li><strong>ABN when you issue one:<\/strong> A voluntary notice should name the item, the estimated cost, and why Medicare will not pay. Keep the signed copy on file.<\/li><li><strong>Proof of delivery:<\/strong> Most supply claims need a signed receipt showing the patient&rsquo;s name, the item, the date received, and a signature.<\/li><\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">A <a href=\"https:\/\/pabau.com\/templates\/medical-necessity-letter\/\">medical necessity letter<\/a> gives the prescriber a consistent format for the clinical rationale, which shortens the back-and-forth with commercial payers. Physical therapy teams managing post-surgical edema face the same paperwork, and <a href=\"https:\/\/pabau.com\/industry\/lp\/physiotherapy-software-us\/\">physical therapy software<\/a> keeps the order and the note in one chart.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Insufficient documentation is one of the most frequently cited causes of improper payments in Medicare&rsquo;s Comprehensive Error Rate Testing program. Consistency across the patient record is the strongest audit defense available. Practices working from <a href=\"https:\/\/pabau.com\/blog\/hipaa-compliance-checklist-for-primary-care\/\">HIPAA-aligned documentation protocols<\/a> hold that standard more easily.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Related HCPCS codes for compression stockings<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Length and construction decide which code applies, and a mismatch is a routine denial. Surgical stockings sit in the A44xx range. Gradient compression stockings sit in the A65xx range and carry an mmHg class in the descriptor.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Code<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Description<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Medicare status<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">A4490<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Surgical stockings above knee length, each<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Non-covered, statutory exclusion<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">A4495<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Surgical stockings thigh length, each<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Non-covered, statutory exclusion<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">A6531<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Gradient compression stocking, below knee, 30-40 mmHg, each<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Covered only to treat an open venous stasis ulcer, with the AW modifier<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">A6532<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Gradient compression stocking, below knee, 40-50 mmHg, each<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Covered only to treat an open venous stasis ulcer, with the AW modifier<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">A6533<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Gradient compression stocking, thigh length, 18-30 mmHg, each<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Non-covered under the surgical dressing benefit<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">Under the surgical dressings policy, only A6531, A6532, and the A6545 wrap are payable, and only for an open venous stasis ulcer. Venous insufficiency without an ulcer, ulcer prevention, and lymphedema without ulcers are all listed as non-covered.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">When A6531 or A6532 is billed for a qualifying ulcer, the claim needs the AW modifier plus RT or LT. That pairing is specific to those codes, and it never appears on an A4490 claim.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A4490 carries no compression class in its descriptor, so it cannot tell a payer how much pressure the garment applies. When the order specifies an mmHg range, the A65xx codes are usually the right family.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The A-series is full of per-unit supply codes that behave this way. <a href=\"https:\/\/pabau.com\/procedure-codes\/hcpcs-code-a4426\/\">A4426<\/a> and <a href=\"https:\/\/pabau.com\/procedure-codes\/hcpcs-code-a4565\/\">A4565<\/a> both bill by the item, and each depends on the descriptor matching the order.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">A4490 vs A4495: Choosing the right length<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Both codes describe surgical stockings for the lower extremity, which is why they get swapped. The difference is garment length, and it has to match the physician&rsquo;s order exactly.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Attribute<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">A4490<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">A4495<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Garment length<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Above knee<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Thigh length<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Typical use<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Coverage needed to just above the knee<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Coverage needed further up the thigh<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Order must specify<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Above knee, or equivalent wording<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Thigh length, or equivalent wording<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Common risk<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Billed when A4495 was ordered, so the length is wrong<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Billed when A4490 was ordered, which reads as upcoding<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">Billing A4495 when the order says above knee is upcoding, which carries compliance risk beyond a denial. The written order is the binding reference, and the billed code follows it. A length-verification step in the claim checklist is enough to stop most of these.<\/p>\n\n\n        <div id=\"pro_tip\">\n            <div class=\"img\">\n                <svg width=\"42\" height=\"42\" viewBox=\"0 0 42 42\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M12.6383 19.5238C12.6632 21.2071 12.8734 22.9926 12.0685 24.5523C11.0341 26.8917 8.45076 28.169 7.56292 30.5918C6.63082 33.1061 7.19505 36.185 9.31371 37.9786C10.929 39.5678 13.4183 39.9873 15.6061 39.5463C17.4592 39.073 19.1049 37.8388 19.9706 36.1608C20.781 34.7141 20.7866 32.9904 20.5293 31.3985C20.1006 29.3092 18.3775 27.8705 16.9807 26.362C14.8814 24.1005 14.6684 20.6854 15.595 17.8915C16.4331 15.4768 19.0026 14.2344 20.0425 11.9461C20.7202 10.6769 20.7506 9.20327 20.6068 7.81304C20.1864 5.40098 18.3139 3.23631 15.8716 2.56674C13.9742 2.03969 11.8224 2.30052 10.1739 3.37614C8.70522 4.34688 7.5878 5.86618 7.28356 7.58178C6.76081 9.82981 7.53525 12.2822 9.20307 13.9118C10.7658 15.4741 12.4806 17.2273 12.6383 19.5238Z\"\n                        fill=\"#2BADD4\" \/>\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M22.7048 19.8387C22.6822 22.3279 24.4507 24.6234 26.7493 25.4682C28.0531 25.961 29.4725 25.9183 30.7989 25.5487C32.0575 24.9955 33.301 24.2237 34.0069 23.0092C34.8384 21.5811 35.2982 19.8286 34.7832 18.2094C34.3611 16.2507 32.8739 14.6541 31.0275 13.9426C28.6736 12.9595 25.8073 13.7942 24.1719 15.7001C23.2022 16.8366 22.6143 18.3326 22.7048 19.8387Z\"\n                        fill=\"#2BADD4\" \/>\n                <\/svg>\n            <\/div>\n            <div class=\"text\">\n                <h3>Pro Tip<\/h3>\n                <p>Cross-reference the physician order for garment length every time A4490 or A4495 appears on a claim. One field on the order prevents the most common stocking denial. Build the check into your claim checklist so it happens every time.<\/p>\n            <\/div>\n        <\/div>\n    \n\n\n<h2 class=\"wp-block-heading\">How Pabau keeps supply claims audit-ready<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Supply billing breaks down at the handoffs. The physician order sits in one system, the delivery receipt in another, and the claim is built from whatever the biller can find. Practice management software like Pabau holds all three against the same patient record.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Pabau&rsquo;s <a href=\"https:\/\/pabau.com\/features\/claims-management-software\/\">claims management software<\/a> traces every supply claim back to its order and note, so billers stop hunting through folders. Because A4490 usually needs a Medicare denial before another payer pays, that trail matters more than usual.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Forms are the other half. Pabau&rsquo;s <a href=\"https:\/\/pabau.com\/features\/patient-intake-software\/\">digital forms<\/a> capture consent, intake, and delivery sign-off at the point of care. The file stays complete for the day an auditor asks for it.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/cdn.pabau.com\/cdn\/attachments\/pulse\/content-engine\/billing_codes\/hcpcs-code-a4490\/customizable-consent-and-intake-forms.webp\" alt=\"Customizable consent and intake forms\"\/><figcaption class=\"wp-element-caption\"><em>Pabau&rsquo;s digital forms capture the order details and delivery sign-off you need on file before an A4490 claim goes out.<\/em><\/figcaption><\/figure>\n\n\n\n<div style=\"height:35px;width:800px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n        <div id=\"book_a_demo\">\n            <div class=\"left-side\">\n                <div class=\"logo\">\n                    <img decoding=\"async\"\n                        src=\"https:\/\/pabau.com\/wp-content\/uploads\/2026\/01\/Logo.svg\"\n                        alt=\"Logo\"\n                        loading=\"lazy\"\n                    \/>\n                <\/div>\n\n                <h3 class=\"heading\">\n                    Keep every supply claim tied to its order                <\/h3>\n\n                <p class=\"description\">\n                    Pabau&rsquo;s claims management and digital forms hold the physician order, the delivery receipt, and the claim in one patient record. Your billers can answer an audit request without hunting through folders.                <\/p>\n\n                <div class=\"button-group\">\n                    <a href=\"\/book-demo\/\" class=\"btn btn-scale-effect btn-cta-color btn-md\">\n                        <span class=\"btn-text\">Book a demo<\/span>\n                        <div class=\"btn-icon btn-icon-right\" aria-hidden=\"true\">\n                            <svg\n                                width=\"14\"\n                                height=\"12\"\n                                viewBox=\"0 0 14 12\"\n                                fill=\"none\"\n                                xmlns=\"http:\/\/www.w3.org\/2000\/svg\"\n                            >\n                                <path\n                                    d=\"M0.75 4.77295C0.335786 4.77295 0 5.10874 0 5.52295C0 5.93716 0.335786 6.27295 0.75 6.27295V5.52295V4.77295ZM13.2803 6.05328C13.5732 5.76039 13.5732 5.28551 13.2803 4.99262L8.50736 0.219648C8.21447 -0.073245 7.73959 -0.073245 7.4467 0.219648C7.15381 0.512542 7.15381 0.987415 7.4467 1.28031L11.6893 5.52295L7.4467 9.76559C7.15381 10.0585 7.15381 10.5334 7.4467 10.8263C7.73959 11.1191 8.21447 11.1191 8.50736 10.8263L13.2803 6.05328ZM0.75 5.52295V6.27295L12.75 6.27295V5.52295V4.77295L0.75 4.77295V5.52295Z\"\n                                    fill=\"currentColor\"\n                                ><\/path>\n                            <\/svg>\n                        <\/div>\n                    <\/a>\n                <\/div>\n            <\/div>\n\n            <div class=\"right-side\">\n                <img decoding=\"async\"\n                    src=\"https:\/\/pabau.com\/wp-content\/uploads\/2026\/01\/Home-Page-Concept-4.webp\"\n                    alt=\"Pabau claims management dashboard\"\n                    loading=\"lazy\"\n                \/>\n            <\/div>\n        <\/div>\n        \n\n\n<h2 class=\"wp-block-heading\">Conclusion<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The useful thing to know about A4490 is that Medicare will not pay it. Once you accept that, the workflow gets simpler. You bill it to produce a denial, or you bill the payer whose plan covers it.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Everything else is order discipline. Match the length code to the written order, count one unit per stocking, and keep the file for seven years. Practices that hold the order, the delivery receipt, and the claim in one system spend less time rebuilding claims later.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/pabau.com\/book-demo\/\">Book a demo<\/a> to see how Pabau ties supply claims to the order and delivery record behind them.<\/p>\n\n\n        <div id=\"expert_picks\">\n            <div class=\"header\">\n                                    <img decoding=\"async\" src=\"https:\/\/pabau.com\/wp-content\/uploads\/2025\/11\/Expert-Picks.svg\" alt=\"Continue your research\" height=\"42\" width=\"42\">\n                                <h3>Continue your research<\/h3>\n            <\/div>\n            <div class=\"content\">\n                                                            <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Billing another A-series supply code?<\/strong> <a href=\"https:\/\/pabau.com\/procedure-codes\/hcpcs-code-b4082\/\">B4082<\/a> walks through the documentation that keeps nasogastric tubing claims from denying.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Need the patient&rsquo;s Medicare consent on file?<\/strong> <a href=\"https:\/\/pabau.com\/templates\/medicare-consent-to-release-form\/\">Medicare consent to release<\/a> gives you a form patients can sign before you bill.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Working out which diagnosis supports the claim?<\/strong> <a href=\"https:\/\/pabau.com\/diagnostic-codes\/icd-10-code-s338xxs\/\">S33.8XXS<\/a> shows how sequencing choices and denial reasons interact on a follow-up encounter.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Billing therapy visits in the home?<\/strong> <a href=\"https:\/\/pabau.com\/procedure-codes\/hcpcs-code-g0152\/\">G0152<\/a> covers unit reporting and Medicare rules for occupational therapy delivered at home.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Coding wound debridement alongside compression care?<\/strong> <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-11043\/\">11043<\/a> sets out the depth documentation and unit rules that decide the claim.<\/p>\n                        <\/div>\n                                                <\/div>\n        <\/div>\n    \n\n\n<h2 class=\"wp-block-heading\">Frequently asked questions<\/h2>\n\n\n\n<div class=\"schema-faq wp-block-yoast-faq-block\"><div class=\"schema-faq-section\" id=\"faq-question-1786698975335\"><h3 class=\"schema-faq-question\">What is HCPCS code A4490 used for?<\/h3> <p class=\"schema-faq-answer\">A4490 is the HCPCS Level II code for one above-knee surgical stocking. Suppliers dispense it under a written physician order, often for venous insufficiency, post-surgical edema, or lymphedema. Thigh-length stockings bill under A4495 instead.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786698975336\"><h3 class=\"schema-faq-question\">Is A4490 covered by Medicare?<\/h3> <p class=\"schema-faq-answer\">No. CMS lists surgical stockings A4490 through A4510 as non-covered under the surgical dressing benefit. Claims are denied as statutorily non-covered, with no benefit category. Bill Medicare only to obtain that denial for a secondary payer, using the GY modifier.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786698975337\"><h3 class=\"schema-faq-question\">Which modifiers apply to A4490?<\/h3> <p class=\"schema-faq-answer\">RT and LT identify the treated leg. GY reports that the item is statutorily excluded from Medicare benefits. GX reports a voluntary Advance Beneficiary Notice. KX does not apply, because a statutory exclusion has no coverage criteria to meet.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786698975338\"><h3 class=\"schema-faq-question\">What is the difference between A4490 and A4495?<\/h3> <p class=\"schema-faq-answer\">A4490 covers above-knee surgical stockings and A4495 covers thigh length. The physician&rsquo;s written order sets the required length, and the billed code must match it. Billing A4495 against an above-knee order is upcoding, and the reverse denies as an incorrect code.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786698975339\"><h3 class=\"schema-faq-question\">How do I bill two surgical stockings for both legs?<\/h3> <p class=\"schema-faq-answer\">Bill two units of A4490 with RT and LT. Some payers want two claim lines, others accept two units on one line. Each stocking is one unit, so a pair billed as a single unit triggers automated edits.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786698975340\"><h3 class=\"schema-faq-question\">What is the reimbursement rate for A4490?<\/h3> <p class=\"schema-faq-answer\">Medicare does not pay A4490, so there is no Medicare rate to quote. For other payers, the amount is whatever your contract or cash-price schedule sets. Check supply pricing in the DMEPOS fee schedule or your DME MAC tool, not the physician fee schedule.<\/p> <\/div> <\/div>\n\n","protected":false},"excerpt":{"rendered":"<p>HCPCS code A4490 is the Level II supply code for one above-knee surgical stocking. The descriptor reads \u00ab\u00a0Surgical stockings above knee length, each\u00a0\u00bb, so one stocking equals one unit. DME suppliers bill it under a written physician order, often for venous insufficiency or post-surgical edema. One detail changes how the whole claim is handled. Medicare [&hellip;]<\/p>\n","protected":false},"author":84,"featured_media":180312,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_yoast_wpseo_linkdex":"77","_yoast_wpseo_content_score":"90","_yoast_wpseo_is_cornerstone":"","_yoast_wpseo_keywordsynonyms":"[\"\",\"\",\"\",\"\"]","_yoast_wpseo_focuskw_text_input":"","_seo_original_html":"","footnotes":""},"categories":[1433,1548],"tags":[1364,1606,3224,1582,2385],"class_list":["post-180314","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-billing-codes","category-hcpcs","tag-billing","tag-dme-billing","tag-dme-mac","tag-hcpcs","tag-medicare-coverage"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v28.2 (Yoast SEO v28.2) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>HCPCS Code A4490: Surgical stockings above knee length<\/title>\n<meta name=\"description\" content=\"A4490 is non-covered by Medicare. Bill the above-knee surgical stocking with GY to obtain a secondary payer denial.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/pabau.com\/fr\/procedure-codes\/hcpcs-code-a4490\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"HCPCS Code A4490: Surgical stockings above knee length\" \/>\n<meta property=\"og:description\" content=\"A4490 is non-covered by Medicare. Bill the above-knee surgical stocking with GY to obtain a secondary payer denial.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/pabau.com\/fr\/procedure-codes\/hcpcs-code-a4490\/\" \/>\n<meta property=\"og:site_name\" content=\"Pabau\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/Pabau\/\" \/>\n<meta property=\"article:published_time\" content=\"2026-08-17T07:16:07+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2026-08-18T13:19:07+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/pabau.com\/wp-content\/uploads\/2026\/08\/hcpcs-code-a4490.webp\" \/>\n\t<meta property=\"og:image:width\" content=\"1200\" \/>\n\t<meta property=\"og:image:height\" content=\"630\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/webp\" \/>\n<meta name=\"author\" content=\"Despina Petrushevska\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:creator\" content=\"@pabaucrm\" \/>\n<meta name=\"twitter:site\" content=\"@pabaucrm\" \/>\n<meta name=\"twitter:label1\" content=\"\u00c9crit par\" \/>\n\t<meta name=\"twitter:data1\" content=\"Despina Petrushevska\" \/>\n\t<meta name=\"twitter:label2\" content=\"Dur\u00e9e de lecture estim\u00e9e\" \/>\n\t<meta name=\"twitter:data2\" content=\"11 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/pabau.com\\\/fr\\\/procedure-codes\\\/hcpcs-code-a4490\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/fr\\\/procedure-codes\\\/hcpcs-code-a4490\\\/\"},\"author\":{\"name\":\"Despina Petrushevska\",\"@id\":\"https:\\\/\\\/pabau.com\\\/fr\\\/#\\\/schema\\\/person\\\/80e6d36732fad68140a849f3c351449b\"},\"headline\":\"HCPCS Code A4490: Surgical stockings above knee length\",\"datePublished\":\"2026-08-17T07:16:07+00:00\",\"dateModified\":\"2026-08-18T13:19:07+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/fr\\\/procedure-codes\\\/hcpcs-code-a4490\\\/\"},\"wordCount\":2185,\"publisher\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/fr\\\/#organization\"},\"image\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/fr\\\/procedure-codes\\\/hcpcs-code-a4490\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/pabau.com\\\/wp-content\\\/uploads\\\/2026\\\/08\\\/hcpcs-code-a4490.webp\",\"keywords\":[\"billing\",\"Dme Billing\",\"Dme Mac\",\"Hcpcs\",\"Medicare coverage\"],\"articleSection\":[\"Billing Codes\",\"HCPCS\"],\"inLanguage\":\"fr-FR\"},{\"@type\":[\"WebPage\",\"FAQPage\"],\"@id\":\"https:\\\/\\\/pabau.com\\\/fr\\\/procedure-codes\\\/hcpcs-code-a4490\\\/\",\"url\":\"https:\\\/\\\/pabau.com\\\/fr\\\/procedure-codes\\\/hcpcs-code-a4490\\\/\",\"name\":\"HCPCS Code A4490: Surgical stockings above knee length\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/fr\\\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/fr\\\/procedure-codes\\\/hcpcs-code-a4490\\\/#primaryimage\"},\"image\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/fr\\\/procedure-codes\\\/hcpcs-code-a4490\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/pabau.com\\\/wp-content\\\/uploads\\\/2026\\\/08\\\/hcpcs-code-a4490.webp\",\"datePublished\":\"2026-08-17T07:16:07+00:00\",\"dateModified\":\"2026-08-18T13:19:07+00:00\",\"description\":\"A4490 is non-covered by Medicare. 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Outside of work, she enjoys photography, weekend getaways, and finding inspiration in everyday experiences.\",\"url\":\"https:\\\/\\\/pabau.com\\\/fr\\\/blog\\\/author\\\/despina-petrushevska\\\/\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/fr\\\/procedure-codes\\\/hcpcs-code-a4490\\\/#faq-question-1786698975335\",\"position\":1,\"url\":\"https:\\\/\\\/pabau.com\\\/fr\\\/procedure-codes\\\/hcpcs-code-a4490\\\/#faq-question-1786698975335\",\"name\":\"What is HCPCS code A4490 used for?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"A4490 is the HCPCS Level II code for one above-knee surgical stocking. Suppliers dispense it under a written physician order, often for venous insufficiency, post-surgical edema, or lymphedema. 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Bill Medicare only to obtain that denial for a secondary payer, using the GY modifier.\",\"inLanguage\":\"fr-FR\"},\"inLanguage\":\"fr-FR\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/fr\\\/procedure-codes\\\/hcpcs-code-a4490\\\/#faq-question-1786698975337\",\"position\":3,\"url\":\"https:\\\/\\\/pabau.com\\\/fr\\\/procedure-codes\\\/hcpcs-code-a4490\\\/#faq-question-1786698975337\",\"name\":\"Which modifiers apply to A4490?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"RT and LT identify the treated leg. GY reports that the item is statutorily excluded from Medicare benefits. GX reports a voluntary Advance Beneficiary Notice. KX does not apply, because a statutory exclusion has no coverage criteria to meet.\",\"inLanguage\":\"fr-FR\"},\"inLanguage\":\"fr-FR\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/fr\\\/procedure-codes\\\/hcpcs-code-a4490\\\/#faq-question-1786698975338\",\"position\":4,\"url\":\"https:\\\/\\\/pabau.com\\\/fr\\\/procedure-codes\\\/hcpcs-code-a4490\\\/#faq-question-1786698975338\",\"name\":\"What is the difference between A4490 and A4495?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"A4490 covers above-knee surgical stockings and A4495 covers thigh length. The physician's written order sets the required length, and the billed code must match it. 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Outside of work, she enjoys photography, weekend getaways, and finding inspiration in everyday experiences.","url":"https:\/\/pabau.com\/fr\/blog\/author\/despina-petrushevska\/"},{"@type":"Question","@id":"https:\/\/pabau.com\/fr\/procedure-codes\/hcpcs-code-a4490\/#faq-question-1786698975335","position":1,"url":"https:\/\/pabau.com\/fr\/procedure-codes\/hcpcs-code-a4490\/#faq-question-1786698975335","name":"What is HCPCS code A4490 used for?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"A4490 is the HCPCS Level II code for one above-knee surgical stocking. Suppliers dispense it under a written physician order, often for venous insufficiency, post-surgical edema, or lymphedema. Thigh-length stockings bill under A4495 instead.","inLanguage":"fr-FR"},"inLanguage":"fr-FR"},{"@type":"Question","@id":"https:\/\/pabau.com\/fr\/procedure-codes\/hcpcs-code-a4490\/#faq-question-1786698975336","position":2,"url":"https:\/\/pabau.com\/fr\/procedure-codes\/hcpcs-code-a4490\/#faq-question-1786698975336","name":"Is A4490 covered by Medicare?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"No. CMS lists surgical stockings A4490 through A4510 as non-covered under the surgical dressing benefit. Claims are denied as statutorily non-covered, with no benefit category. Bill Medicare only to obtain that denial for a secondary payer, using the GY modifier.","inLanguage":"fr-FR"},"inLanguage":"fr-FR"},{"@type":"Question","@id":"https:\/\/pabau.com\/fr\/procedure-codes\/hcpcs-code-a4490\/#faq-question-1786698975337","position":3,"url":"https:\/\/pabau.com\/fr\/procedure-codes\/hcpcs-code-a4490\/#faq-question-1786698975337","name":"Which modifiers apply to A4490?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"RT and LT identify the treated leg. GY reports that the item is statutorily excluded from Medicare benefits. GX reports a voluntary Advance Beneficiary Notice. KX does not apply, because a statutory exclusion has no coverage criteria to meet.","inLanguage":"fr-FR"},"inLanguage":"fr-FR"},{"@type":"Question","@id":"https:\/\/pabau.com\/fr\/procedure-codes\/hcpcs-code-a4490\/#faq-question-1786698975338","position":4,"url":"https:\/\/pabau.com\/fr\/procedure-codes\/hcpcs-code-a4490\/#faq-question-1786698975338","name":"What is the difference between A4490 and A4495?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"A4490 covers above-knee surgical stockings and A4495 covers thigh length. The physician's written order sets the required length, and the billed code must match it. Billing A4495 against an above-knee order is upcoding, and the reverse denies as an incorrect code.","inLanguage":"fr-FR"},"inLanguage":"fr-FR"},{"@type":"Question","@id":"https:\/\/pabau.com\/fr\/procedure-codes\/hcpcs-code-a4490\/#faq-question-1786698975339","position":5,"url":"https:\/\/pabau.com\/fr\/procedure-codes\/hcpcs-code-a4490\/#faq-question-1786698975339","name":"How do I bill two surgical stockings for both legs?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"Bill two units of A4490 with RT and LT. Some payers want two claim lines, others accept two units on one line. Each stocking is one unit, so a pair billed as a single unit triggers automated edits.","inLanguage":"fr-FR"},"inLanguage":"fr-FR"},{"@type":"Question","@id":"https:\/\/pabau.com\/fr\/procedure-codes\/hcpcs-code-a4490\/#faq-question-1786698975340","position":6,"url":"https:\/\/pabau.com\/fr\/procedure-codes\/hcpcs-code-a4490\/#faq-question-1786698975340","name":"What is the reimbursement rate for A4490?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"Medicare does not pay A4490, so there is no Medicare rate to quote. For other payers, the amount is whatever your contract or cash-price schedule sets. Check supply pricing in the DMEPOS fee schedule or your DME MAC tool, not the physician fee schedule.","inLanguage":"fr-FR"},"inLanguage":"fr-FR"}]}},"yoast":{"focus_keyword":"HCPCS Code A4490","seo_title":"HCPCS Code A4490: Surgical stockings above knee length","meta_description":"A4490 is non-covered by Medicare. 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