A6255 — Specialty absorptive dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing

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)

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.