HCPCS Level II › A codes A6211 Foam drg > 48 sq in w/o brdrFoam dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing
Medicare coverage: Special coverage instructions apply Status: active (October 2026 file) Medically Unlikely Edits (effective October 1, 2026) Practitioner: max 0 units per day (clinical), rationale: CMS Policy Medicare pricing for A6211 DMEPOS fee schedule, July 2026 (DME26-C) no modifier, surgical dressings (SD): non-rural $41.86 in the contiguous states; $41.86 to $50.18 in AK, HI, PR and VI; ceiling $41.86, floor $35.58 Physician Fee Schedule (CY 2026, RVU26D) Status P: bundled or excluded, no separate PFS payment.
Payer policies and prior authorization for A6211 Payer coverage policies that name A6211 A6211 appears in 3 coverage policies from Aetna.
Payer Policy Role in policy Reviewed Document Aetna Dialysis (0541) covered if criteria are met (range A6010-A6457) Aug 26, 2026 payer document Aetna Skin and Soft Tissue Substitutes (0244) not covered (range A6209-A6211) Jul 29, 2026 payer document Aetna Surgical Devices, Dressings, and Wound Care Supplies (0526) covered if criteria are met (range A6209-A6215) Aug 26, 2026 payer document
Medicaid fee-for-service Prior authorization required or conditional in CO, KY, LA, MA, OH, VA, WV.
AZ: $49.96 (dme), effective Oct 1, 2026 CO: $34.18 (chp_plus, non-facility), effective Jul 1, 2026 FL: $24.04 (dme), effective Jul 1, 2026 IL: $28.71 (dme), effective Jan 1, 2026 IN: $34.88 (professional, Advanced Practice Nurse (85%), non-facility), effective Jan 1, 2026 KS: $33.49 (default), effective Jul 1, 2026 KY: $28.01 (dme), effective Jan 1, 2026 LA: $18.88 (dme), effective Sep 1, 2021 MA: $34.07 (dme_rates), effective Mar 1, 2026 MD: $35.58 (dme), effective Apr 1, 2026 MS: $33.49 (comprehensive), effective Jul 1, 2026 ND: $51.65 (dme), effective Aug 1, 2026 NE: $36.62 (dme), effective Jul 1, 2026 NY: $28.74 (dme), effective Jul 1, 2026 OH: $29.30 (dme), effective Jan 1, 2024 OK: $41.86 (dme), effective Jan 1, 2026 TX: $28.01 (dmepos_tos_9_e_j_l_and_r, Home Health Dme, non-facility), effective Jul 1, 1997 VA: $37.67 (dme), effective Dec 1, 2026 VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $31.46 (medical_equipment_supplies), effective Jul 1, 2026 WY: $0.00 (outpatient_hospital_apc, Children's Hospitals), effective Apr 1, 2026 From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.