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A6243 — Hydrogel dressing, wound cover, 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: “Hydrogel drg >16<=48 w/o bdr”

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
Face-to-face & WOPD
Not on the required 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.

Order readiness — what the written order must contain

Every Medicare DMEPOS claim needs a Standard Written Order with all six elements (42 CFR 410.38(d)):

  • Beneficiary name or Medicare Beneficiary Identifier (MBI) (42 CFR 410.38(d)(1)(i)(A))
  • General description of the item (42 CFR 410.38(d)(1)(i)(B))
  • Quantity to be dispensed, if applicable (42 CFR 410.38(d)(1)(i)(C))
  • Order date (42 CFR 410.38(d)(1)(i)(D))
  • Treating practitioner name or NPI (42 CFR 410.38(d)(1)(i)(E))
  • Treating practitioner signature (42 CFR 410.38(d)(1)(i)(F))

Not on the F2F/WOPD list (April 13, 2026 update — 83 items). The standard written order must reach the supplier before claim submission.

Blank requirements checklist only — MyMedi-AI never collects or stores completed orders.

A6243 Medicare fee schedule (April 2026)

Base (no modifier) Surgical dressings

Medicare allowable ranges from $17.56 to $21.02 depending on state and rural status.

Former-CBA payment limits: ceiling $17.56 · floor $14.93

StateNon-ruralRural
AK$17.72
AL$17.56
AR$17.56
AZ$17.56
CA$17.56
CO$17.56
CT$17.56
DC$17.56
DE$17.56
FL$17.56
GA$17.56
HI$18.96
IA$17.56
ID$17.56
IL$17.56
IN$17.56
KS$17.56
KY$17.56
LA$17.56
MA$17.56
MD$17.56
ME$17.56
MI$17.56
MN$17.56
MO$17.56
MS$17.56
MT$17.56
NC$17.56
ND$17.56
NE$17.56
NH$17.56
NJ$17.56
NM$17.56
NV$17.56
NY$17.56
OH$17.56
OK$17.56
OR$17.56
PA$17.56
PR$21.02
RI$17.56
SC$17.56
SD$17.56
TN$17.56
TX$17.56
UT$17.56
VA$17.56
VI$17.56
VT$17.56
WA$17.56
WI$17.56
WV$17.56
WY$17.56
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

Related A-codes

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