HCPCS Level II › A codes A6456 Zinc paste band w >=3"<5"/ydZinc paste impregnated bandage, non-elastic, knitted/woven, width greater than or equal to three inches and less than five inches, per yard
Medicare coverage: Carrier judgment Status: active (October 2026 file) Medically Unlikely Edits (effective October 1, 2026) Practitioner: max 0 units per day (clinical), rationale: CMS Policy Outpatient hospital: max 20 units per day (clinical), rationale: Clinical: Data Medicare pricing for A6456 DMEPOS fee schedule, July 2026 (DME26-C) no modifier, surgical dressings (SD): non-rural $1.79 in the contiguous states; $1.79 to $2.19 in AK, HI, PR and VI; ceiling $1.79, floor $1.52 Physician Fee Schedule (CY 2026, RVU26D) Status X: statutory exclusion, not paid under the PFS.
Payer policies and prior authorization for A6456 Payer coverage policies that name A6456 A6456 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 Aug 26, 2026 payer document Aetna Urological Supplies (0533) not covered Jul 30, 2026 payer document
Medicaid fee-for-service Prior authorization required or conditional in CO, KY, MA, OH, VA, WV.
AZ: $2.14 (dme), effective Oct 1, 2026 CO: $1.46 (chp_plus, non-facility), effective Jul 1, 2026 FL: $9.76 (dme), effective Jul 1, 2026 IL: $1.22 (dme), effective Jan 1, 2026 IN: $1.49 (professional, Advanced Practice Nurse (85%), non-facility), effective Jan 1, 2026 KS: $1.43 (default), effective Jul 1, 2026 KY: $1.02 (dme), effective Jan 1, 2026 MA: $1.45 (dme_rates), effective Mar 1, 2026 MD: $1.52 (dme), effective Apr 1, 2026 MS: $1.43 (comprehensive), effective Jul 1, 2026 ND: $0.00 (dme), effective Aug 1, 2026 NE: $1.57 (dme), effective Jul 1, 2026 NY: $0.81 (dme), effective Jul 1, 2026 OH: $1.20 (dme), effective Jan 1, 2024 OK: $1.79 (dme), effective Jan 1, 2026 TX: $1.14 (dmepos_tos_9_e_j_l_and_r, Home Health Dme, non-facility), effective Jul 1, 2004 VA: $1.61 (dme), effective Dec 1, 2026 VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $1.36 (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.