HCPCS Level II › A codes A6215 Foam dressing wound fillerFoam dressing, wound filler, sterile, per gram
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 A6215 Physician Fee Schedule (CY 2026, RVU26D) Status P: bundled or excluded, no separate PFS payment.
Payer policies and prior authorization for A6215 Payer coverage policies that name A6215 A6215 appears in 3 coverage policies from Aetna.
Payer Policy Role in policy Reviewed Document Aetna Devices for Post-Operative Use Following Endoscopic Sinus Surgery (0840) not covered Dec 4, 2025 payer document Aetna Dialysis (0541) covered if criteria are met (range A6010-A6457) Aug 26, 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, IL, KY, LA, MA, OH, VA, WV.
CO: $2.02 (health_first_colorado), effective Jul 1, 2026 IN: $0.19 (professional, Advanced Practice Nurse (85%), non-facility), effective Jan 1, 2026 KS: $1.00 (default), effective Sep 1, 2007 KY: $0.05 (dme), effective Jan 1, 2026 LA: $1.57 (dme), effective Sep 1, 2021 MD: $14.67 (dme), effective Apr 1, 2026 OH: $1.23 (dme), effective Jun 28, 2006 TX: $0.00 (dmepos_tos_9_e_j_l_and_r, Medical Supplier (Dme), non-facility), effective Jul 1, 1997 VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $2.89 (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.