HCPCS Level II › A codes A6457 Tubular dressingTubular dressing with or without elastic, any width, per linear 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 12 units per day (clinical), rationale: Clinical: Data Medicare pricing for A6457 DMEPOS fee schedule, July 2026 (DME26-C) no modifier, surgical dressings (SD): non-rural $1.62 in the contiguous states; $1.62 to $1.99 in AK, HI, PR and VI; ceiling $1.62, floor $1.38 Physician Fee Schedule (CY 2026, RVU26D) Status X: statutory exclusion, not paid under the PFS.
Payer policies and prior authorization for A6457 Payer coverage policies that name A6457 A6457 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) listed, no stance Aug 26, 2026 payer document
Medicaid fee-for-service Prior authorization required or conditional in CO, KY, MA, OH, VA.
AZ: $1.93 (dme), effective Oct 1, 2026 CO: $1.11 (chp_plus, non-facility), effective Jul 1, 2026 FL: $0.98 (dme), effective Jul 1, 2026 IL: $1.11 (dme), effective Jan 1, 2026 IN: $1.35 (professional, Advanced Practice Nurse (85%), non-facility), effective Jan 1, 2026 KS: $1.30 (default), effective Jul 1, 2026 KY: $0.91 (dme), effective Jan 1, 2026 MA: $1.32 (dme_rates), effective Mar 1, 2026 MD: $1.38 (dme), effective Apr 1, 2026 MS: $1.30 (comprehensive), effective Jul 1, 2026 ND: $1.25 (dme), effective Aug 1, 2026 NE: $1.41 (dme), effective Jul 1, 2026 NY: $1.21 (dme), effective Jul 1, 2026 OH: $1.27 (dme), effective Jan 1, 2026 OK: $1.62 (dme), effective Jan 1, 2026 TX: $1.14 (dmepos_tos_9_e_j_l_and_r, Home Health Dme, non-facility), effective Jan 1, 2006 VA: $1.46 (dme), effective Dec 1, 2026 VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $1.23 (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.