MyMedi-AI

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 (HCPCS Level II October 2026)

Prior authorization

Not on the Medicare required-PA list (CMS Required Prior Authorization List — 74 items in force on 2026-10-16; 8 more from 2026-10-28; sources: CMS list updated 2026-01-13, CMS-6109-N (91 FR 47972)). 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 (CMS Required F2F & WOPD List — 83 items in force on 2026-10-16; 22 more from 2026-10-28; sources: CMS list effective 2026-04-13 (91 FR 1250), CMS-6109-N (91 FR 47972)). 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 (October 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 October 2026 (CMS DMEPOS Fee Schedule October 2026 (DME26-D)). 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

Bill A6243 with confidence

MyMedi-AI scrubs whole claims against CMS MUE limits, modifier rules, and PA and F2F/WOPD flags before you submit — built for DME teams, PHI-free: no patient data is collected or stored.

Start free trial   Run a CMS-0057-F readiness check

Prefer DIY compliance? Self-audit documentation kits for DME suppliers →

Building an AI agent? Try the agent API in the playground — free PA-required lookups, A6243 included, and starter credits via POST /bot-marketplace/register.