A6242 Hydrogel drg <=16 in w/o bdrHydrogel dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing
Status P: bundled or excluded, no separate PFS payment.
1 of 1 payer prior-auth lists that name A6242 require prior authorization or set conditions: Medicare.
| Payer | Plan | State | Prior auth | Conditions | Since | Source |
|---|---|---|---|---|---|---|
| Medicare | DMEPOS Master List (items potentially subject to PA) | All | prior auth under conditions | On the Master List; PA only if CMS selects it for the Required List | Jul 30, 2026 | Master List of DMEPOS Items Potentially Subject to Face-to-Face Encounter and Written Order Prior to Delivery and/or Prior Authorization Requirements |
A6242 appears in 2 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 A6242-A6248) | Aug 26, 2026 | payer document |
Prior authorization required or conditional in CO, KY, LA, MA, OH, VA, WV.
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.