Compression Therapy Coding Guide: CPT, HCPCS A-Codes, ICD-10 Mapping and DME Rules
Accurate coding is the foundation of compression therapy reimbursement—and one of the most common failure points in wound care billing. As payer audits intensify and documentation standards tighten, even small coding errors can trigger medical necessity denials, downcoding, or post-payment recoupments. For clinics that routinely apply multi-layer compression wraps, Unna boots, compression garments, or pneumatic compression devices, incorrect CPT or HCPCS selection quietly erodes revenue month after month.
Most denials happen not because the treatment was inappropriate, but because the wrong CPT or HCPCS code was selected, modifiers were missing, or the documentation didn’t support the code billed. For example, CPT 29580 and CPT 29581 may seem similar, yet they represent entirely different procedures. HCPCS supply codes like A6452 or A6530 require precise usage based on payer rules—and many clinics unknowingly bill them incorrectly. Meanwhile, pneumatic compression device codes (E0650–E0652) involve strict conservative therapy requirements that are often misunderstood.
For a full overview of how compression therapy is billed and clinical documentation requirements, refer to our Compression Therapy Billing Guide. This coding guide is designed as a companion resource, offering deeper insight into how to code compression therapy accurately and avoid preventable denials. Today, payers are no longer accepting vague or incomplete compression coding. They expect claims to clearly reflect:
- What type of compression was applied
- Which anatomical area was treated
- Whether supplies or DME were used
- Whether the treatment qualifies as a procedure vs. a supply
- Whether the documentation matches the CPT or HCPCS code
This guide focuses specifically on coding accuracy. It breaks down every CPT and HCPCS code used for compression therapy, explaining when each applies, what documentation is required, and how to avoid coding pitfalls that trigger denials. Whether you are coding multi-layer wraps, Unna boots, compression supplies, or pneumatic compression devices, this guide gives you step-by-step instructions to code confidently and compliantly.
If your practice wants to strengthen coding accuracy, prevent recoupments, and ensure faster reimbursement, our Wound Care Billing & Coding Services can audit your compression therapy documentation and coding practices to help secure proper payment the first time.
Blog Outline
- Overview of CPT vs HCPCS Codes in Compression Therapy
- CPT Codes Used for Compression Therapy (29580, 29581, 29582 Explained)
- HCPCS Codes for Compression Therapy Supplies (A-Codes)
- Compression Stockings Coding (A6530–A6549 DME)
- Pneumatic Compression Device Coding (E0650–E0652)
- ICD-10 Codes That Support Compression Therapy (Medical Necessity Map)
- Conclusion: Accurate Coding Protects Compliance, Reimbursement, and Patient Care
Overview of CPT vs HCPCS Codes in Compression Therapy
Before selecting the correct code for compression therapy, it is essential to understand whether the service qualifies as a procedure (CPT) or a supply/DME item (HCPCS). This distinction drives reimbursement, documentation requirements, and modifier use—yet it remains one of the most common sources of error in wound care and vascular practices. Compression therapy can fall into any of the following categories:
CPT Codes = Procedures Performed by a Provider
CPT codes describe hands-on procedures performed by a clinician. In compression therapy, these primarily include:
- CPT 29580 — Unna boot application
- CPT 29581 — Multi-layer compression wrap (lower leg)
- CPT 29582 — Multi-layer compression wrap (upper extremity/other areas)
These codes require:
- Direct provider involvement
- Detailed documentation of the compression technique
- Diagnosis linking that supports medical necessity
- Laterality modifiers (RT/LT) where appropriate
When billed correctly, these procedures are among the most reimbursable compression services.
For additional billing context—including documentation expectations and clinical use cases—refer to our comprehensive Compression Therapy Billing Guide.
HCPCS Codes = Supplies and DME Items
HCPCS Level II codes describe materials, equipment, and supplies, not procedures.
These codes include:
A-codes (Supplies)
Used for elastic wraps, bandages, multilayer dressing components, and compression garments:
- A6450–A6456 — Elastic bandages
- A6441–A6452 — Non-elastic and multi-layer wrap components
- A6530–A6549 — Gradient compression stockings (DME category)
These codes may or may not be separately billable depending on:
- Site of service
- Payer bundling rules
- Whether a CPT compression procedure was performed
- Whether the patient is in a SNF or HHA setting
E-codes (DME Devices)
Used for intermittent pneumatic compression devices and related components:
- E0650 — Nonsegmental pump
- E0651 — Segmental pump
- E0652 — Segmental pump with calibrated gradient pressure
These require:
- Proof of conservative therapy failure
- Limb measurements
- Medical necessity documentation
- Prior authorization (common with commercial payers)
For a deeper breakdown of payer coverage criteria, visit our Compression Therapy Insurance Coverage Guide.
When CPT and HCPCS Codes Can Be Billed Together
This is where most coding mistakes occur.
Allowed together (when permitted by payer):
✔ CPT 29581 (multi-layer wrap) + ✔ A-code supply (if not bundled AND payer covers it)
Not allowed together:
✘ CPT 29581 + compression stockings (A6530–A6549)
✘ CPT 29580 + routine ACE bandages
✘ CPT compression codes within consolidated billing settings (SNF Part A)
Each payer has its own bundling logic, which is why internal coordination between coders, clinicians, and billers is crucial.
Quick Comparison Table: CPT vs HCPCS for Compression Therapy
| Use Case | Code Type | Code Range | Who Bills It | Notes |
|---|---|---|---|---|
| Compression procedure (wrap or boot applied) | CPT | 29580–29582 | Clinician | Requires procedure documentation |
| Compression supplies | HCPCS A-codes | A6450–A6549 | Clinic or DME vendor | Coverage varies by payer |
| Pneumatic compression pumps | HCPCS E-codes | E0650–E0652 | DME supplier/clinic | Requires PA + conservative therapy failure |
| Routine bandaging | No reimbursement | N/A | N/A | Considered non-covered unless tied to wound care |
This table will help coders quickly identify whether a compression service should be billed as a procedure, supply, DME, or non-covered item.
CPT Codes Used for Compression Therapy (29580, 29581, 29582 Explained)
Correctly selecting the appropriate CPT code is essential for proper reimbursement. While compression therapy may appear clinically straightforward, each CPT code carries specific documentation, anatomical, and medical necessity requirements. Misuse of these codes is a leading cause of CO-50 denials, payer audits, and claim downcoding. Below is a detailed breakdown of all CPT codes associated with compression therapy.
CPT 29580 — Application of Unna Boot
Definition
CPT 29580 represents the application of an Unna boot, a medicated (usually zinc-oxide) paste bandage applied from the foot to just below the knee to treat venous stasis ulcers and chronic venous insufficiency.
When to Use CPT 29580
Use this code when the provider:
- Applies a zinc-oxide impregnated bandage
- Wraps the lower extremity using the Unna boot technique
- Treats a qualifying condition such as venous ulceration or significant venous insufficiency
Required Documentation
To avoid denials, charting must include:
- Venous diagnosis (I87.2, L97.x series, etc.)
- Wound description with measurements
- Edema grading or CEAP classification
- Laterality (right/left leg)
- Technique used (e.g., zinc-oxide bandage from metatarsal heads to tibial tuberosity)
Common ICD-10 Pairings
- I87.2 — Chronic venous insufficiency
- L97.2xx / L97.3xx — Venous stasis ulcers
- I89.0 — Lymphedema (when clinically appropriate)
Modifiers
- RT / LT — Required for laterality
- 59 / XU — If billed with certain wound-care procedures
- KX — If LCD criteria must be attested (Medicare)
CPT 29581 — Application of Multi-Layer Venous Compression System (Lower Leg)
Definition
CPT 29581 is used to describe a multi-layer compression wrap applied to a lower extremity (typically 3- or 4-layer systems). This is the most commonly underbilled compression therapy code in wound care.
When to Use CPT 29581
Bill this code when a provider:
- Applies a multi-layer compression system
- Treats venous insufficiency, venous ulcers, or severe edema
- Documents all layers applied (padding, absorbent layer, bandage, compression layer)
Required Documentation
Payers now require:
- CEAP classification (C4–C6 preferred)
- Edema grading (1+–4+)
- Wound measurements (L × W × D)
- Clinical rationale for high-compression therapy
- Patient tolerance and post-procedure condition
Missing CEAP or wound details is one of the most common causes of CO-50 denials.
Common ICD-10 Pairings
- L97.2xx / L97.3xx — Venous ulcers
- I87.2 — Venous insufficiency
- I89.0 — Lymphedema
Modifiers
- RT / LT — Required
- 59 / XU — If billing alongside debridement codes
- KX — When the local coverage determination (LCD) requires it
Key Guidance
Do not bill A-code supplies with CPT 29581 unless:
- Payer policy explicitly allows it
- The setting is non-facility (e.g., office POS 11)
CPT 29582 — Multi-Layer Compression System (Upper Extremity / Other Areas)
Definition
CPT 29582 covers compression wraps applied to upper extremities, thighs, or other anatomical sites, not the lower leg addressed by 29581.
When to Use CPT 29582
Appropriate when applying:
- Multi-layer wraps to upper extremities for lymphedema
- Compression for post-surgical edema in arms or thighs
- Treatment of chronic swelling beyond the lower leg
Required Documentation
Must include:
- Exact anatomical site
- Edema severity
- Limb measurements (circumference)
- Reason for compression
- Description of layers applied
Common ICD-10 Pairings
- I89.0 — Lymphedema
- R60.9 / R60.0 — Edema (only when clinically justified and not routine care)
- I97.2 — Post-mastectomy lymphedema
Modifiers
- RT / LT when applicable
- 59 / XU when billed with other wound care procedures
CPT Code Comparison Table (29580 vs 29581 vs 29582)
| CPT Code | Description | Anatomical Area | Best Use Case | Documentation Must Include |
|---|---|---|---|---|
| CPT 29580 | Unna boot application | Lower extremity | Venous ulcers, stasis dermatitis | Wound measurements, CEAP classification, zinc-oxide boot usage |
| CPT 29581 | Multi-layer compression wrap | Lower leg | Venous insufficiency, multilayer treatment | Wound details, edema grade, CEAP classification |
| CPT 29582 | Multi-layer compression wrap | Upper extremity or other areas | Lymphedema, post-surgery edema | Limb measurements, site-specific edema documentation |
HCPCS Codes for Compression Therapy Supplies (A-Codes)
While CPT codes capture procedures, HCPCS Level II codes describe the supplies, materials, and garments used in compression therapy. These codes are frequently misunderstood because payers classify many compression supplies as routine, non-covered, or bundled depending on the setting of care. The correct use of A-codes is essential for both compliance and maximizing reimbursement. Below is a breakdown of the primary HCPCS categories used in compression therapy.
Elastic & Non-Elastic Bandages (A6450–A6456)
These are among the most commonly used compression supplies—but also the most frequently denied. Payers often consider them routine, non-covered supplies unless tied directly to active wound care and billed under specific circumstances.
HCPCS Codes in This Family
| Code | Description |
|---|---|
| HCPCS A6450 | Elastic bandage, 2-inch width |
| HCPCS A6451 | Elastic bandage, 3-inch width |
| HCPCS A6452 | Elastic bandage, 4-inch width |
| HCPCS A6453–A6456 | Larger widths and non-sterile elastic bandage variants |
Billing Notes
- Rarely reimbursed in physician offices unless tied to wound care AND payer explicitly allows it.
- Often bundled into CPT procedures such as 29581 or wound debridement.
- May be separately payable in home care or DME settings depending on payer policy.
Documentation Requirements
- Must state why standard dressings were not sufficient.
- Link to specific wound or edema diagnosis.
- Detail the number of bandages used.
Multi-Layer Compression Supplies (A6441–A6452)
These are components of multi-layer compression systems, used in 3-layer or 4-layer wraps. Although the procedure (CPT 29581) is billable, the supplies may or may not be, depending on the payer and place of service.
When These Codes Are Used
- Multi-layer wraps for venous insufficiency
- Advanced compression applications in wound care
- Additional absorbent, padding, or cohesive layers
Key HCPCS Codes
| Code | Description |
|---|---|
| A6441–A6449 | Multiple-layer compression wrap components |
| A6450–A6452 | Elastic bandages used as part of multi-layer compression systems |
Billing Rules
✔ Allowed in:
- Some commercial plans
- Some Medicaid programs
- Home health care settings
✘ Not allowed / bundled in:
- Medicare Part B physician offices
- Hospital outpatient departments (OPPS bundling)
- Most SNF Part A stays (consolidated billing)
Documentation Requirements
- Each layer applied
- Reason for multi-layer compression
- Number of units used
- Medical necessity tied to venous disease or lymphedema
Gradient Compression Stockings (A6530–A6549) — DME Category
These codes generate the highest denial rates across all compression-related HCPCS billing.
Why?
Because Medicare and most commercial plans classify stockings as non-covered DME, except under specific circumstances (e.g., lymphedema or surgical dressing benefits).
Common Codes
| Code | Description |
|---|---|
| A6530–A6539 | Below-knee compression stockings with varying compression strengths |
| A6540–A6549 | Thigh-high or full-leg compression garments |
Coverage Notes
- Not covered for venous insufficiency alone
- Sometimes covered for chronic lymphedema
- Often limited to 2–4 pairs per year
- Must often be billed through a DME supplier, not a physician clinic
Critical Documentation
- Lymphedema diagnosis
- Detailed limb measurements
- History of ulcer recurrence or edema progression
- Conservative therapy attempts
Surgical Dressings & Supplies Tied to Compression (A6200–A6457)
Some compression supplies fall under surgical dressing policies, especially when used with an active wound.
Examples include:
- Absorbent padding
- Cohesive outer wraps
- Non-adhesive dressings under compression
- Zinc oxide pastes (if part of a dressing system)
Coverage depends heavily on:
- Presence of a qualifying wound
- Documentation of wound depth & exudate
- Payer-specific surgical dressing LCDs
| HCPCS Range | Description | Coverage Likelihood | Notes |
|---|---|---|---|
| HCPCS A6450–A6456 | Elastic bandages | Low | Often considered routine care |
| HCPCS A6441–A6452 | Multi-layer wrap supplies | Moderate | Bundling rules vary by payer |
| HCPCS A6530–A6549 | Compression stockings | Low–Moderate | DME limits and non-coverage are common |
| HCPCS A6200–A6457 | Surgical dressing components | Moderate–High | Must meet wound dressing LCD requirements |
Compression Stockings Coding (A6530–A6549 DME)
Gradient compression stockings continue to generate the highest denial rate of any compression-related HCPCS family—primarily because most payers, including Medicare, classify them as non-covered DME unless strict medical necessity criteria are met. Coders must understand when these codes are billable, when they are excluded, and what documentation is required to avoid automatic denials. The A6530–A6549 code range includes below-knee, thigh-high, and full-leg compression garments typically prescribed for venous disease, lymphedema, and post-surgical swelling. However, coverage hinges on diagnosis, setting, and payer policy.
HCPCS Codes in the Compression Stocking Family
| Code Range | Description | Typical Use | Coverage Outlook |
|---|---|---|---|
| HCPCS A6530–A6539 | Below-knee gradient compression stockings | Venous disease, lymphedema | Low to moderate (payer dependent) |
| HCPCS A6540–A6549 | Thigh-high or full-leg compression stockings | Lymphedema, post-surgical swelling | Limited; often requires DME vendor |
These codes are categorized as DME, not medical supplies, which means:
- Physician offices often cannot bill them directly
- Payers may require a certified DME supplier
- Prior authorization may apply for commercial plans
- Medicare applies strict non-coverage rules
When Compression Stockings Are Covered (Rare but Possible)
Most insurers—including Medicare—deny stocking claims unless they meet one of the following exceptions:
✔ Lymphedema (I89.0)
- Some payers allow coverage when stockings are prescribed as part of long-term lymphedema management.
✔ Post-thrombotic syndrome (with documentation of chronic edema or venous obstruction)
✔ Part of a surgical dressing (rare scenario)
Medicare allows coverage only when stockings meet the criteria under surgical dressing policies, such as after skin grafts or surgical wounds requiring compression.
When Compression Stockings Are NOT Covered (Most Cases)
Expect denials if billed for:
- Venous insufficiency alone (I87.2)
- Varicose veins (I83.x)
- Chronic edema without functional limitation (R60.xx)
- Ulcer prevention
- Post-ulcer healing maintenance
These fall under Medicare’s definition of “personal comfort items” and are considered patient responsibility.
Commercial insurers may follow similar logic, although some plans allow limited coverage with prior authorization.
Required Documentation for Covered Claims
When coverage is possible, documentation must include:
- Diagnosis (lymphedema, post-thrombotic syndrome, etc.)
- Limb measurements at multiple levels
- Evidence of clinical necessity
- Prior conservative therapy
- Compression strength required (20–30, 30–40, 40–50 mmHg)
- Frequency of replacement (typically 2–4 pairs per year allowed)
Missing limb measurements is the most common documentation error.
Correct Billing Pathway for Compression Stockings
Because stockings are DME:
- Use NU (new) or RR (rental) modifiers if payer requires
- Bill via DMEPOS channels, not E/M or wound care pathways
- Check whether the payer requires:
- Prior authorization
- Certificate of medical necessity
- Proof of failure of lower-compression garments
For claims through Medicare, expect non-coverage unless tied to a surgical dressing benefit.
Real-World Example: Covered vs. Denied Claim
Denied Claim Example
- HCPCS: A6530 (Below-knee stocking)
- ICD-10: I87.2 (Venous insufficiency)
- Outcome: Denied — “Routine care / not medically necessary”
Reason: Venous insufficiency alone does not support stocking coverage.
Approved Claim Example
- HCPCS: A6541 (Thigh-high compression garment)
- ICD-10: I89.0 (Lymphedema)
- Documentation:
- Limb circumference: 54 cm → 49 cm after therapy
- Failed conservative therapy for 6 weeks
- Photos provided to payer
Outcome: Approved after PA — meets criteria for chronic lymphedema.
Pneumatic Compression Device Coding (E0650–E0652)
Intermittent pneumatic compression (IPC) devices are high-value DME items commonly used for chronic lymphedema, severe venous insufficiency with refractory edema, and select post-thrombotic syndromes. They require precise HCPCS coding (E0650–E0652), strong medical necessity documentation, and often prior authorization. Mistakes in coding or documentation usually result in immediate denials or requests for additional clinical records. This section explains the codes, when each applies, what payers expect for coverage in 2025, and how to construct an audit-proof claim.
HCPCS Codes — What They Mean
| HCPCS | Short Description |
|---|---|
| HCPCS E0650 | Intermittent pneumatic compression device, non-segmental |
| HCPCS E0651 | Intermittent pneumatic compression device, segmental |
| HCPCS E0652 | Intermittent pneumatic compression device, segmental with calibrated gradient pressure |
Key distinction: Segmental devices (E0651, E0652) provide independent inflation/deflation across chambers and are often preferred/required for lymphedema. E0652 adds calibrated gradient control.
Clinical & Coverage Criteria (What Payers Want to See)
Most payers (Medicare, Medicaid, and commercial) require similar foundational documentation before paying for an IPC pump. While exact wording varies by plan, the following elements are universally expected:
- Definitive diagnosis supporting IPC (e.g., I89.0 — lymphedema; documented post-thrombotic syndrome; severe refractory edema).
- Failure of conservative therapy documented over time (typically ≥4 weeks). Conservative therapy includes compression garments, elevation, exercise, manual lymphatic drainage, topical care, and skin care.
- Objective limb measurements (circumference at standardized anatomical points, before and after conservative therapy or during therapy trials).
- Treatment goal and expected functional benefit (e.g., reduce limb volume to prevent recurrent cellulitis, improve mobility).
- Trial of IPC (if required by payer) with documented response, or explicit clinical rationale for immediate home use.
- Supplier documentation showing DMEPOS enrollment and proper face-to-face encounter notes where required.
- Photographs are often requested by commercial plans and by some MACs for Medicare Advantage reviews.
Refer to your payer’s LCD or coverage policy for exact thresholds and wording; where available, include direct quotes from the policy in the justification.
Documentation Template — Minimum Required Elements
Use a structured template in the chart. At minimum, include:
- Patient name, DOB, and date of evaluation.
- Diagnosis code(s) and clinical history.
- Conservative therapy timeline with dates and clinician notes.
- Limb circumference measurements at standard points (e.g., dorsum, 10 cm above lateral malleolus, calf).
- Objective statement of failure or insufficient response to conservative care.
- Specific device requested (segmental vs non-segmental) and medical rationale.
- Supplier information and DMEPOS credentials.
- Signed face-to-face encounter (if required by payer).
Including a short physician justification paragraph such as “IPC device medically necessary because patient with chronic lymphedema failed ≥4 weeks of conservative therapy, documented limb volume reduction <10% and recurrent cellulitis risk” will help preempt requests for more info.
Prior Authorization & Supplier Requirements
- Medicare Part B (traditional): While some MACs do not require prior authorization for E065x, they will require robust documentation upon audit. Medicare Advantage plans and many commercial payers typically require prior authorization.
- Commercial plans: PA almost always required; each plan has specific forms and evidence requirements.
- DME Supplier: Must be enrolled in Medicare DMEPOS and meet local supplier standards. Ensure supplier maintains proof of delivery (POD), face-to-face encounter documentation (if applicable), and all warranty/repair records.
Before submitting, run a payer-specific authorization check and attach the PA number to the claim when required.
Correct Claim Construction & Modifiers
- Place HCPCS (E0650–E0652) in the DME line item(s).
- Include ICD-10 codes that justify medical necessity (e.g., I89.0 for lymphedema).
- Modifiers: NU (new equipment), RR (rental), or UE/UZ (if applicable) per payer rules. Many payers prefer rental reporting for pumps; follow payer-specific NU/RR guidance.
- KX modifier is rarely used with E-codes but may be applied in instances where LCDs require attestation; review the applicable LCD.
If billing through a clinician (e.g., physician-owned DME), ensure charges are separated properly between professional services and equipment lines.
Common Denials & How to Avoid Them
| Denial Cause | Fix / Prevention |
|---|---|
| Lack of documented conservative therapy | Include dated conservative therapy notes and show a clear treatment timeline |
| Missing limb measurements | Add standardized circumference chart entries |
| Supplier not DMEPOS enrolled | Verify supplier enrollment and PTAN before ordering |
| Incorrect modifier (e.g., NU vs RR) | Follow payer-specific rental vs purchase policy |
| No face-to-face encounter | Ensure physician or nurse practitioner documents a face-to-face or telehealth visit if required |
| Missing PA | Obtain and attach prior authorization number with supporting clinical notes |
Example Claim Scenarios
Example A — Approved (Medicare Advantage with PA)
- HCPCS: E0651 (segmental pump)
- ICD-10: I89.0 (lymphedema)
- Documentation: 6 weeks of conservative therapy documented, limb circumferences pre/post, trial IPC response during clinic visit, PA attached.
- Outcome: Approved with rental arrangement.
Example B — Denied (No Conservative Therapy)
- HCPCS: E0650
- ICD-10: I89.0
- Documentation: Face-to-face visit present but no conservative therapy timeline or measurements.
Outcome: Denied for medical necessity. Appeal requires retrospective conservative therapy evidence.
Tips for DME Suppliers & Billing Teams
- Pre-screen each referral against the payer’s LCD/PA checklist before order submission.
- Collect detailed limb measurements and conservative therapy logs before dispensation.
- Use standardized measurement templates to reduce variability.
- Keep photos in the chart and attach when required by payer PA portals.
- If PA is denied, request peer-to-peer review using physician-authored rationale and objective measures.
ICD-10 Codes That Support Compression Therapy (Medical Necessity Map)
Correct ICD-10 selection is one of the strongest predictors of reimbursement success for compression therapy. Payers increasingly deny compression claims when the associated diagnosis does not demonstrate medical necessity (CO-50), even if the procedure is clinically appropriate. This section provides a complete medical necessity mapping for compression therapy, including ICD-10 codes that support:
- Unna boots (CPT 29580)
- Multi-layer compression wraps (CPT 29581, 29582)
- Compression bandaging supplies (A-codes)
- Pneumatic compression devices (E0650–E0652)
These diagnosis codes must align with clinical documentation, including wound measurements, CEAP classification, edema grading, and conservative therapy history (when applicable).
Primary ICD-10 Codes That Support Compression Therapy
These codes represent strong medical necessity for compression therapy, consistently validated across Medicare LCDs and commercial payer policies.
A. Venous Insufficiency & Chronic Venous Hypertension
| ICD-10 | Description |
|---|---|
| ICD I87.2 | Chronic venous insufficiency |
| ICD I87.011–I87.019 | Chronic venous hypertension with ulcer |
| ICD I87.021–I87.029 | Chronic venous hypertension with inflammation |
| ICD I87.031–I87.039 | Chronic venous hypertension with ulcer & inflammation |
Clinical Relevance:
These diagnoses strongly justify CPT 29580 (Unna boot) and CPT 29581 (multi-layer venous wrap) when paired with wound documentation.
B. Venous Stasis Ulcers (L97.x Series)
These are among the strongest ICD-10 indicators for compression therapy.
| ICD-10 Range | Description |
|---|---|
| ICD L97.2xx | Ulcers of calf (right/left) |
| ICD L97.3xx | Ulcers of ankle (right/left) |
| ICD L97.4xx / L97.5xx | Midfoot / heel ulcers |
| ICD L97.8xx / L97.9xx | Lower-extremity ulcers, other & unspecified |
Documentation Requirement: Must include depth (breakdown of skin, fat layer exposed, necrosis, bone involvement).
C. Lymphedema & Lymphatic Disorders
| ICD-10 | Description |
|---|---|
| ICD I89.0 | Lymphedema, not elsewhere classified |
| ICD Q82.0 | Congenital lymphedema |
| ICD I97.2 | Post-mastectomy lymphedema |
Best matched with:
- CPT 29582 (upper-extremity multi-layer wrap)
- IPC pumps (E0651, E0652)
Lymphedema is a leading indication for pneumatic compression device coverage.
D. Edema Codes That Support Compression Therapy (When Properly Documented)
Some edema codes can support compression therapy only when accompanied by clinical severity and functional impairment.
| ICD-10 | Description | Notes |
|---|---|---|
| ICD R60.0 | Localized edema | Must document medical necessity; often denied alone |
| ICD R60.1 | Generalized edema | Use caution; link to underlying cause |
| ICD R60.9 | Edema, unspecified | Weak standalone code; pair with venous/lymphatic codes |
Warning:
Billing compression therapy only with R60.x is a common reason for CO-50 denials.
Always pair R60.x with a root cause such as I87.x, L97.x, or I89.0.
E. Post-Thrombotic Syndrome & Vascular Disorders
Some edema codes can support compression therapy only when accompanied by clinical severity and functional impairment.
| ICD-10 | Description |
|---|---|
| ICD I82.5xx | Chronic DVT / iliac or femoral thrombosis |
| ICD I87.0 | Post-thrombotic syndrome |
| ICD I73.9 | Peripheral vascular disease (use with caution) |
These codes support compression therapy when the clinical notes link the therapy to:
- Refractory edema
- Venous insufficiency
- Chronic swelling
- Limb heaviness or ulcer risk
ICD-10 Codes That Do NOT Support Compression Therapy Alone
Avoid pairing these diagnoses with 29580/29581/29582 unless documentation justifies medical necessity:
| ICD-10 | Description |
|---|---|
| ICD M79.89 | Leg swelling (non-specific) |
| ICD R22.4 | Localized swelling, lower limb |
| ICD Z48.00–Z48.03 | Aftercare codes |
| ICD Z09 / Z51.89 | Follow-up encounters |
| ICD Z74.x | Limited mobility |
ICD-10 Mapping Table — Which Diagnoses Support Which Codes
| ICD-10 Category | Supports CPT 29580 | Supports CPT 29581 | Supports CPT 29582 | Supports DME (E0650–E0652) |
|---|---|---|---|---|
| Venous ulcers (L97.x) | ✔ | ✔ | ✔ (if upper extremity) | Sometimes |
| Venous insufficiency (I87.2) | ✔ | ✔ | Conditional | Rare |
| Lymphedema (I89.0) | ✔ | ✔ | ✔ | ✔✔✔ Strongest |
| Post-thrombotic syndrome | ✔ | ✔ | ✔ | ✔ |
| Edema (R60.x) | Conditional | Conditional | Conditional | Conditional |
| Post-surgical swelling (I97.2) | ✖ | ✖ | ✔ | ✔ |
| Varicose veins (I83.x) | ✔ if ulcer present | ✔ if ulcer present | Conditional | Rare |
Example ICD-10 Documentation That Passes Audits
Example 1 — Venous Ulcer + Multi-Layer Compression (29581)
“CEAP C6 venous insufficiency. Venous ulcer on right lower leg measuring 3.1 × 2.8 × 0.2 cm. Moderate serous drainage. Edema 3+. Applied 4-layer compression. Patient tolerated well.”
Codes: CPT 29581 + ICD-10 L97.212 + I87.2
Example 2 — Lymphedema + Pneumatic Compression Device (E0651)
“Stage II lymphedema of left arm. Limb circumference 41 cm → 39 cm after conservative therapy (6 weeks). Minimal improvement. Home IPC device medically necessary to prevent progression.”
Codes: E0651 + ICD-10 I89.0
Example 3 — Incorrect (Denied Claim)
CPT 29581
ICD-10: R60.0 (Localized edema)
Denied: Does not support medical necessity.
Correct approach: Add underlying disease diagnosis (e.g., I87.2).
Conclusion
Compression therapy is one of the most clinically effective yet administratively challenging services in wound care. From CPT procedures like 29580 and 29581 to HCPCS supply codes and DME categories such as E0651 and A6530, every code carries strict billing rules, documentation expectations, and payer-specific coverage criteria. The smallest gaps—missing CEAP classification, incomplete limb measurements, incorrect pairing of ICD-10 codes, or improper modifier use—can instantly convert a medically necessary treatment into a denied claim.
Correct coding is more than a billing task. It is a compliance safeguard, a revenue protection strategy, and a patient care enabler. When providers and billing teams apply the correct CPT, HCPCS, and ICD-10 codes, reimbursement becomes predictable, audits become manageable, and clinicians are free to focus on healing rather than paperwork. When coding is inaccurate, practices face CO-50 denials, recoupments, audit exposure, and delayed patient care plans.
As payer rules continue tightening in 2025, coding compression therapy without expert support becomes increasingly risky. That is why clinics, wound centers, DME suppliers, SNFs, and vascular providers trust MedStates to manage the complexity. Our team understands LCD policies, payer-by-payer coverage nuances, and the documentation details that make or break compression therapy claims.
We help you code correctly— the first time, every time.
Strengthen Your Compression Therapy Billing With MedStates
If your organization is struggling with:
- CPT/HCPCS uncertainty
- Recurring denials for compression wraps or DME pumps
- Incorrect ICD-10 pairings
- Unpredictable reimbursement
- Complex payer coverage rules
- Audit concerns or charting inconsistencies
Our wound care billing experts will evaluate your current compression therapy documentation, coding patterns, and payer denials—and show you exactly what to fix to improve approvals and eliminate preventable revenue loss.
