2025 HCPCS code A6243

A sterile hydrogel wound cover dressing, more than 16 but less than or equal to 48 square inches, without an adhesive border.

Follow HCPCS coding guidelines for medical and surgical supplies, particularly those related to wound care and dressing selection. Adhere to payer-specific guidelines for medical necessity and documentation requirements.

Modifiers such as AW (item furnished in conjunction with a surgical dressing), LT (left side), RT (right side), and quantity modifiers (e.g., A1-A9 for number of wounds) may be applicable depending on the clinical scenario.

Medical necessity for A6243 is established when the use of a hydrogel dressing is clinically indicated for the type and size of wound. Documentation should support the choice of dressing based on the wound's characteristics and the patient's clinical status.Medicare requires explicit documentation.

The physician or other qualified healthcare professional is responsible for determining the medical necessity of the hydrogel dressing and for ensuring that the appropriate size is selected for the wound. They are also responsible for documenting the use of the dressing in the patient's medical record.

IMPORTANT A6242 (for dressings 16 sq inches or less), A6244 (for dressings larger than 48 sq inches).Modifiers may be required to specify the number of wounds treated and location (LT/RT).

In simple words: This code is for a special type of bandage (a hydrogel dressing) used to help heal wounds.It's larger than a small bandage but smaller than a very large one, and it doesn't have a sticky edge. Your doctor must show it's needed for your treatment.

HCPCS code A6243 represents a sterile hydrogel wound cover dressing designed to cover open wounds, maintaining a moist and cool environment.The dressing's pad size must be appropriate for the wound, falling within the range of more than 16 square inches but less than or equal to 48 square inches. Importantly, this code specifies a dressing without an adhesive border. Medicare coverage requires appropriate medical necessity documentation.

Example 1: A patient presents with a second-degree burn measuring 20 square inches on their lower leg. The physician orders A6243 for wound coverage and moisture management., A patient with a chronic venous ulcer requiring regular dressing changes has a wound measuring 35 square inches.The physician selects A6243 as the appropriate dressing size and documents its use as part of the overall wound care plan., A patient with a surgical incision of 40 square inches is discharged home with A6243 for self-application at home. The instructions for use and appropriate wound care are documented in the discharge summary. Modifier AW is applied.

Documentation should include the size of the wound, the type of wound, the reason for using a hydrogel dressing, and the number of dressings used.The physician's order for the dressing should also be documented.For home use, appropriate patient education and discharge instructions must be recorded.

** This code is specific to sterile hydrogel dressings without adhesive borders.Always verify the size of the dressing to ensure accurate coding.Consider using modifier AW if provided with a surgical dressing.

** Only Enterprise users with EHR integration can access case-specific answers. Click here to request access.