Medicare Part B Reference Sheet

This reference tool provides indications and limitations of coverage for surgical dressings.

Disclaimer: The information presented in this document is an interpretation and summary of information available to the public. The information is general and does not constitute medical advice. Application of the information to any particular patient should be determined only by a qualified medical professional. Byram and its employees take no responsibility for the accuracy of this information or the application of this information as to a particular patient. This information is current as of 07/24/2017, and may change.

Collagen Dressings

Collagen is the protein that gives strength to the skin, therefore, making collagen appropriate for stalled wounds. There are various collagen technologies available. Collagen can be derived from various sources such as bovine, equine, Piscean, ovine, porcine, and avian. Dressing formulations include particles, powder, gel, sheets, and pads.

A6010 collagen wound filler dry COLLAGEN BASED WOUND FILLER, DRY FORM, STERILE, PER GRAM OF COLLAGEN

A6011 collagen wound filler gel pastes per gram COLLAGEN BASED WOUND FILLER, GEL/PASTE, PER GRAM OF COLLAGEN

A6021 collagen dressing pad size 16 sq COLLAGEN DRESSING, STERILE, SIZE 16 SQ. IN. OR LESS, EACH

A6023 collagen dressing pad size more COLLAGEN DRESSING, STERILE, SIZE MORE THAN 48 SQ. IN., EACH

A6024 collagen dressing wound filler per 6 COLLAGEN DRESSING WOUND FILLER, STERILE, PER 6 INCHES

Alginate Dressings

Alginates are derived from seaweed and designed to absorb high amounts of exudate. They promote autolytic debridement while maintaining an optimal moist wound environment enhancing wound healing. There are pads and rope available.

A6196 alginate fiber gelling dressing wound cover ALGINATE OR OTHER FIBER GELLING DRESSING, WOUND COVER, STERILE, PAD SIZE 16 SQ. IN. OR LESS, EACH DRESSING

A6197 alginate fiber gelling dressing wound cover ALGINATE OR OTHER FIBER GELLING DRESSING, WOUND COVER, STERILE, PAD SIZE MORE THAN 16 SQ. IN. BUT LESS THAN OR EQUAL TO 48 SQ. IN., EACH DRESSING

A6199 alginate fiber gelling dressing wound filler ALGINATE OR OTHER FIBER GELLING DRESSING, WOUND FILLER, STERILE, PER 6 INCHES

Composite Dressings

Composite dressings are multifunctional in providing a protective barrier, promoting autolytic debridement, and moldable. This dressing is comprised of a non-adherent pad and is available with and without a border of retention tape or transparent film. Absorbency is minimal to moderate.

A6203 composite dressing pad size 16 sq COMPOSITE DRESSING, STERILE, PAD SIZE 16 SQ. IN. OR LESS, WITH ANY SIZE ADHESIVE BORDER, EACH DRESSING

A6204 composite dressing pad size more than COMPOSITE DRESSING, STERILE, PAD SIZE MORE THAN 16 SQ. IN. BUT LESS THAN OR EQUAL TO 48 SQ. IN., WITH ANY SIZE ADHESIVE BORDER, EACH DRESSING

Contact Layer Dressings

These dressings provide and interface between the wound and the dressing protecting healing wound tissues. Contact layers wick exudate away from the wound and protect the wound base.

A6207 contact layer more than 16 sq CONTACT LAYER, STERILE, MORE THAN 16 SQ. IN. BUT LESS THAN OR EQUAL TO 48 SQ. IN., EACH DRESSING

Foams (bordered and non-bordered)

Foam dressings can be bordered or non-bordered. They absorb moderate to heavy exudate. Foams are also used as a prophylactic dressing in preventing injury to the periwound or skin. This dressing is conformable, non-adherent, thermoregulating, and a protective barrier.

A6209 foam dressing wound cover pad size FOAM DRESSING, WOUND COVER, STERILE, PAD SIZE 16 SQ. IN. OR LESS, WITHOUT ADHESIVE BORDER, EACH DRESSING

A6210 foam dressing wound cover pad size FOAM DRESSING, WOUND COVER, STERILE, PAD SIZE MORE THAN 16 SQ. IN. BUT LESS THAN OR EQUAL TO 48 SQ. IN., WITHOUT ADHESIVE BORDER, EACH DRESSING

A6211 foam dressing wound cover pad size FOAM DRESSING, WOUND COVER, STERILE, PAD SIZE MORE THAN 48 SQ. IN., WITHOUT ADHESIVE BORDER, EACH DRESSING

A6212 foam dressing wound cover pad size FOAM DRESSING, WOUND COVER, STERILE, PAD SIZE 16 SQ. IN. OR LESS, WITH ANY SIZE ADHESIVE BORDER, EACH DRESSING

A6214 foam dressing wound cover pad size FOAM DRESSING, WOUND COVER, STERILE, PAD SIZE MORE THAN 48 SQ. IN., WITH ANY SIZE ADHESIVE BORDER, EACH DRESSING

Gauze (non-impregnated) Dressings

Gauzes or non-woven or woven. They are not all the same and depending on what the usage is, determines which gauze is most appropriate. Gauze can be used for cleansing wounds, packing wounds, and covering wounds.

A6219 gauze nonimpregnated pad size 16 sq GAUZE, NON-IMPREGNATED, STERILE, PAD SIZE 16 SQ. IN. OR LESS, WITH ANY SIZE ADHESIVE BORDER, EACH DRESSING

A6220 gauze nonimpregnated pad size more than GAUZE, NON-IMPREGNATED, STERILE, PAD SIZE MORE THAN 16 SQ. IN. BUT LESS THAN OR EQUAL TO 48 SQ. IN., WITH ANY SIZE ADHESIVE BORDER, EACH DRESSING

Gauze (impregnated) Dressings

A6231 gauze impregnated hydrogel direct wound contact GAUZE, IMPREGNATED, HYDROGEL, FOR DIRECT WOUND CONTACT, STERILE, PAD SIZE 16 SQ. IN. OR LESS, EACH DRESSING

A6232 gauze impregnated hydrogel direct wound contact GAUZE, IMPREGNATED, HYDROGEL, FOR DIRECT WOUND CONTACT, STERILE, PAD SIZE GREATER THAN 16 SQ. IN., BUT LESS THAN OR EQUAL TO 48 SQ. IN., EACH DRESSING

Hydrocolloid Dressings

Hydrocolloids come in different shapes, sizes, and thicknesses. There are gels, powders, sheets, and wafers. Hydrocolloids promote autolytic debridement and provide a protective barrier.

A6234 hydrocolloid dressing wound cover pad size HYDROCOLLOID DRESSING, WOUND COVER, STERILE, PAD SIZE 16 SQ. IN. OR LESS, WITHOUT ADHESIVE BORDER, EACH DRESSING

A6235 hydrocolloid dressing wound cover pad size HYDROCOLLOID DRESSING, WOUND COVER, STERILE, PAD SIZE MORE THAN 16 SQ. IN. BUT LESS THAN OR EQUAL TO 48 SQ. IN., WITHOUT ADHESIVE BORDER, EACH DRESSING

A6236 hydrocolloid dressing wound cover pad size HYDROCOLLOID DRESSING, WOUND COVER, STERILE, PAD SIZE MORE THAN 48 SQ. IN., WITHOUT ADHESIVE BORDER, EACH DRESSING

A6237 hydrocolloid dressing wound cover pad size HYDROCOLLOID DRESSING, WOUND COVER, STERILE, PAD SIZE 16 SQ. IN. OR LESS, WITH ANY SIZE ADHESIVE BORDER, EACH DRESSING

A6238 hydrocolloid dressing wound cover pad size HYDROCOLLOID DRESSING, WOUND COVER, STERILE, PAD SIZE MORE THAN 16 SQ. IN. BUT LESS THAN OR EQUAL TO 48 SQ. IN., WITH ANY SIZE ADHESIVE BORDER, EACH DRESSING

Wound Filler Dressings

Wound fillers help manage exudate and fill in dead space of deeper wounds. Fillers can be time-released with antimicrobial properties and are available in gels, pads, pastes, beads, strands, and pillows.

A6240 hydrocolloid dressing wound filler paste per 1 oz. HYDROCOLLOID DRESSING, WOUND FILLER, PASTE, STERILE, PER OUNCE

A6241 hydrocolloid dressing wound filler dry form HYDROCOLLOID DRESSING, WOUND FILLER, DRY FORM, STERILE, PER GRAM

Hydrogel Dressings

Hydrogel is used to donate moisture to a dry wound, promote autolysis, and enhance granulation formation. There are various forms such as gels, pads, impregnated gauzes, and sheets.

A6242 hydrogel dressing wound cover pad size HYDROGEL DRESSING, WOUND COVER, STERILE, PAD SIZE 16 SQ. IN. OR LESS, WITHOUT ADHESIVE BORDER, EACH DRESSING

A6243 hydrogel dressing wound cover pad size HYDROGEL DRESSING, WOUND COVER, STERILE, PAD SIZE MORE THAN 16 SQ. IN. BUT LESS THAN OR EQUAL TO 48 SQ. IN., WITHOUT ADHESIVE BORDER, EACH DRESSING

A6244 hydrogel dressing wound cover pad size HYDROGEL DRESSING, WOUND COVER, STERILE, PAD SIZE MORE THAN 48 SQ. IN., WITHOUT ADHESIVE BORDER, EACH DRESSING

A6245 hydrogel dressing wound cover pad size HYDROGEL DRESSING, WOUND COVER, STERILE, PAD SIZE 16 SQ. IN. OR LESS, WITH ANY SIZE ADHESIVE BORDER, EACH DRESSING