| HCPCS Code: |
A6223 |
| Long Description: |
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size more than 16 sq. in., but less than or equal to 48 sq. in., without adhesive border, each dressing |
| Short Description: |
Gauze >16<=48 no w/sal w/o b |
| Pricing Indicator 1: |
35 (Surgical dressings (price subject to floors and ceilings)) |
| Multiple Pricing Code: |
A (Not applicable as HCPCS priced under one methodology) |
| MCM Reference Section Number 1: |
2079 |
| Statute Number: |
|
| Coverage Code: |
D (Special coverage instructions apply) |
| ASC Payment Group Code: |
|
| Processing Note Number: |
|
| Berenson-Eggers Type of Service (BETOS) Code: |
D1A (Medical/surgical supplies) |
| Type of Service Code 1: |
S (Surgical dressings or other medical supplies (effective 04/95)) |
| Anesthesia Base Unit Quality: |
0 |
| Code Added: |
01-01-1997 |
| Action Effective Date: |
01-01-2009 |
| Action Code: |
N (No maintenance for this code) |
