A6217 — Gauze, non-impregnated, non-sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing

HCPCS Level II A-code · short descriptor: “Non-sterile gauze>16<=48 sq”

Code system: HCPCS Level II
Family: A — Medical & surgical supplies, ambulance
Medicare coverage status: Special coverage instructions apply
DMEPOS payment category: Surgical dressings
Prior authorization: Not on Medicare required-PA list
Status: Active (April 2026 HCPCS)

Prior authorization

Not on the Medicare required-PA list as of the January 13, 2026 update (74 items). Medicare Advantage and commercial plans set their own prior-authorization rules for this code — verify per plan before delivery.

A6217 Medicare fee schedule (April 2026)

Base (no modifier) Surgical dressings

No fee-schedule amount is published for this line (carrier-priced or not separately payable).

Amounts are the Medicare DMEPOS fee-schedule allowables effective April 2026. Medicare typically pays 80% of the allowable after the Part B deductible; the patient owes 20%. A 2% sequestration reduction applies to the Medicare share. Former competitive-bidding-area adjustments and non-continental rates can differ — verify with your DME MAC.

Common denial codes to watch

CO-50 medical necessity

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