2025 HCPCS code A6216
(Active) Effective Date: N/A Revision Date: N/A Medical Supplies - Gauze Dressings Medical and Surgical Supplies Feed
Supply of non-impregnated, non-sterile gauze dressing; pad size ≤ 16 sq. in., without adhesive border.
Modifiers A1-A9 can be appended to indicate the number of wounds dressed; modifiers AW (item furnished in conjunction with surgical dressing), LT (left side), and RT (right side) may also apply.
Medical necessity is established by documentation supporting the need for the gauze dressing to manage the wound, such as a physician's assessment of the wound, the need for absorption of exudate, prevention of infection, or wound protection.
The clinical responsibility involves assessing the wound, determining the appropriate size and type of dressing, applying the dressing, and providing instructions for wound care and dressing changes (if applicable).Documentation of medical necessity is crucial for reimbursement.
In simple words: This code covers the cost of a small, non-sticky gauze pad used to cover a wound.It's not a sterile dressing, and the doctor bills separately for applying it.
This HCPCS code reports the supply of a single, non-impregnated, non-sterile gauze dressing with a pad size of 16 square inches or less and without an adhesive border.It is used to dress open wounds, absorb exudate, and protect wounds from infection. The code covers the supply only; application is billed separately.The size must be appropriate for the wound.Medicare coverage requires medical necessity documentation.
Example 1: A patient presents with a small laceration on their forearm requiring a simple gauze dressing.A6216 is used to bill for the supply of the gauze dressing.The application of the dressing may be billed under a separate CPT code., A patient with a stage 1 pressure ulcer on their sacrum needs a dressing change. The physician uses a single gauze dressing (A6216) for the wound.Documentation includes wound assessment, type of dressing used, and plan of care., A patient is discharged with instructions for wound care at home. The provider supplies several small gauze dressings (A6216) to the patient for at-home dressing changes. The discharge summary includes specific instructions for wound care and dressing change frequency.The place of service should reflect the patient’s home (POS 12).
Detailed wound assessment, including location, size, depth, presence of exudate, and any signs of infection; type and size of dressing used; date and time of application; patient instructions for wound care and dressing changes.
** This code is for the supply of the gauze dressing only.Separate codes are necessary for the application and any other related procedures.Always refer to the most current HCPCS code set for accurate billing information.
- Payment Status: Active
- Modifier TC rule: Not applicable.This is a supply code.
- Specialties:Wound care, general surgery, family medicine, dermatology
- Place of Service:Office, Inpatient Hospital, Outpatient Hospital, Ambulatory Surgical Center, Home (POS 12)