HCPCS Level II › A codes A6224 Gauze > 48 in no w/sal w/o bGauze, impregnated with other than water, normal saline, or hydrogel, 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 A6224 DMEPOS fee schedule, July 2026 (DME26-C) no modifier, surgical dressings (SD): non-rural $5.13 in the contiguous states; $5.13 to $6.19 in AK, HI, PR and VI; ceiling $5.13, floor $4.36 Physician Fee Schedule (CY 2026, RVU26D) Status P: bundled or excluded, no separate PFS payment.
Payer policies and prior authorization for A6224 Payer coverage policies that name A6224 A6224 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 Surgical Devices, Dressings, and Wound Care Supplies (0526) covered if criteria are met (range A6222-A6233) Aug 26, 2026 payer document Aetna Urological Supplies (0533) not covered (range A6216-A6233) Jul 30, 2026 payer document
Medicaid fee-for-service Prior authorization required or conditional in CO, KY, LA, MA, OH, VA, WV.
AZ: $6.12 (dme), effective Oct 1, 2026 CO: $3.53 (chp_plus, non-facility), effective Jul 1, 2026 FL: $2.96 (dme), effective Jul 1, 2026 IL: $3.52 (dme), effective Jan 1, 2026 IN: $4.28 (professional, Advanced Practice Nurse (85%), non-facility), effective Jan 1, 2026 KS: $4.10 (default), effective Jul 1, 2026 KY: $3.44 (dme), effective Jan 1, 2026 LA: $2.32 (dme), effective Sep 1, 2021 MA: $4.17 (dme_rates), effective Mar 1, 2026 MD: $4.36 (dme), effective Apr 1, 2026 MS: $4.10 (comprehensive), effective Jul 1, 2026 ND: $0.00 (dme), effective Aug 1, 2026 NE: $4.48 (dme), effective Jul 1, 2026 NY: $1.81 (dme), effective Jul 1, 2026 OH: $2.60 (dme), effective Jan 1, 1997 OK: $5.13 (dme), effective Jan 1, 2026 TX: $3.44 (dmepos_tos_9_e_j_l_and_r, Home Health Dme, non-facility), effective Jul 1, 1997 VA: $4.62 (dme), effective Dec 1, 2026 VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $3.87 (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.