HCPCS Level II A6197: Alginate/Fiber Gelling Sterile Wound Dressing, Large Pad

Commercial payers pay $17 on average nationally for this procedure.

HCPCS Level II code A6197 describes a sterile alginate or other fiber gelling wound dressing in a pad size greater than 16 square inches and up to 48 square inches; the service is wound dressing application or supply for management of moderate to large surface-area wounds, typically provided in outpatient wound care clinics, dermatology or primary care offices, and skilled nursing or long-term care settings as a sterile wound cover product.

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National Reimbursement Benchmarks

National commercial pricing for HCPCS A6197 centers around a BUCA average commercial rate of $16.6, with Blue Cross Blue Shield showing the highest dispersion and Aetna and UnitedHealth Group showing comparatively tighter spreads. Blue Cross Blue Shield’s interquartile range (P75–P25) is $6.4, indicating substantial variability in contracted rates, while Cigna’s IQR is $11.6 and suggests notable mid‑market divergence despite a consistent lower quartile. BUCA’s mean of $16.6 provides a convenient midpoint for average commercial expectations.

Aetna’s IQR is $4.0 and UnitedHealth Group’s IQR is $6.5, making Aetna the tightest in the cohort and UnitedHealth Group slightly wider but still more constrained than Blue Cross Blue Shield and Cigna. Cigna’s P75–P25 of $11.6 is the widest of the set, reflecting broader negotiated outcomes, while BUCA and UnitedHealth Group offer intermediate dispersion around the BUCA average.

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HCPCS Level II A6197: Alginate/Fiber Gelling Sterile Wound Dressing, Large Pad

Commercial payers pay $17 on average nationally for this procedure.

Customize your policy alerts

Sign up for hcpcs A6197 policy alerts

Get alerted when payer policies referencing A6197 are released or updated.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

National Reimbursement Benchmarks

National Payer Mean Reimbursement Rates

Clinical & Coding Specifications

Clinical Context

A 68-year-old patient with peripheral vascular disease and type 2 diabetes presents to an outpatient wound care clinic for management of a non-healing lower leg ulcer. The wound measures 20 square inches after cleansing, demonstrates moderate exudate but no obvious deep tissue infection, and requires a sterile fiber-gelling alginate dressing sized greater than 16 sq. in. but ≤48 sq. in. The typical clinical workflow includes wound assessment (size, depth, exudate, signs of infection), wound cleansing and moisture management, possible selective or non-selective debridement if indicated, application of a sterile alginate or other fiber gelling dressing (A6197) cut to size or applied as supplied, dressing securement, and patient/caregiver education on offloading and follow-up. Supply documentation includes wound measurements, dressing type and size (A6197), lot numbers if required, frequency of dressing changes, and clinical rationale tied to the diagnosis code (for example L97.909). Typical sites of service are outpatient wound care clinics, home health visits performed by a wound care nurse, outpatient dermatology or family medicine clinics, and hospital outpatient departments when wound management is provided as an ambulatory service.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`97597`	Debridement, open wound, first 20 sq cm or less	Debridement may be performed prior to application of `A6197` when devitalized tissue impedes healing.
`97602`	Wound(s) care, non-selective debridement; without anesthesia, for removal of devitalized tissue	Performed in wound care visits prior to dressing application when mechanical or non-selective debridement is required.
`A6209`	Foam dressing, wound cover, sterile, pad size 16 sq. in. or less	Alternative dressing supply for smaller wounds; comparison when selecting appropriate dressing size and type.
`A6212`	Composite dressing, sterile, pad size 16 sq. in. or less	Alternative sterile dressing option for wounds requiring a different dressing construct or smaller pad sizes.

Related Modifiers

7 rows

Modifier	Description	When to Use
26	Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…	- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
52	Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…	- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
53	Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…	- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
59	Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…	- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
62	Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…	- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
78	CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…	- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
80	CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…	- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…

Related Provider Taxonomies

8 rows

Taxonomy Code	Specialty	Notes
163WC0400X	Case Management Registered Nurse	Nursing Service Providers · Registered Nurse
207Q00000X	Family Medicine Physician	Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadt…
208D00000X	General Practice Physician	A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions.
133VN1401X	Pediatric Critical Care Nutrition Registered Dietitian	An individual who is a Board Certified Specialist in Pediatric Critical Care Nutrition and applies evidence-based nutrition knowledge in providing med…
163WN0002X	Neonatal Intensive Care Registered Nurse	Nursing Service Providers · Registered Nurse
1223P0300X	Periodontics	That specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the tee…
225XP0200X	Pediatric Occupational Therapist	Occupational therapists provide services to infants, toddlers and children who have or who are at risk for developmental delays or disabilities. Occup…
344600000X	Taxi	A land commercial vehicle used for the transporting of persons in non-emergency situations. The vehicle meets local, county or state regulations set f…

Related ICD-10-CM Codes

28 rows

ICD-10-CM Code	Description
E10.621	Type 1 diabetes mellitus with foot ulcer
E11.621	Type 2 diabetes mellitus with foot ulcer
I83.019	Varicose veins of right lower extremity with ulcer of unspecified site
I87.2	Venous insufficiency (chronic) (peripheral)
K11.3	Abscess of salivary gland
K92.2	Gastrointestinal hemorrhage, unspecified
L03.115	Cellulitis of right lower limb
L03.116	Cellulitis of left lower limb
L08.9	Local infection of the skin and subcutaneous tissue, unspecified
L30.9	Dermatitis, unspecified

Showing 1–10 of 28

Related Codes

HCPCS-A4206-STERILE-SYRINGE-1CC-NEEDLE

HCPCS A4206: Syringe with Needle, 1 cc or Less, Sterile

HCPCS-A4207-STERILE-2CC-SYRINGE-WITH-NEEDLE

HCPCS Level II A4207: Syringe with Needle, Sterile 2 cc

HCPCS-A4208-STERILE-3CC-SYRINGE-WITH-NEEDLE

HCPCS Level II A4208: Syringe with Needle, Sterile 3 cc

HCPCS-A4209-STERILE-SYRINGE-WITH-NEEDLE-5CC-OR-GREATER

HCPCS Level II A4209: Syringe with Needle, Sterile 5 cc or Greater

HCPCS-A4210-NEEDLE-FREE-INJECTION-DEVICE

HCPCS Level II A4210: Needle-free Injection Device, Each

HCPCS-A4211-SUPPLIES-SELF-ADMINISTERED-INJECTIONS

HCPCS Level II A4211: Supplies for Self-Administered Injections

HCPCS-A4212-NON-CORING-NEEDLE-STYLET-CATHETER-ACCESS-SUPPLY

HCPCS Level II A4212: Non-coring Needle or Stylet with/without Catheter

HCPCS-A4213-STERILE-SYRINGE-20CC-OR-GREATER

HCPCS Level II A4213: Syringe, Sterile, 20 cc or Greater, Each

HCPCS-A4215-STERILE-NEEDLE-SINGLE-EACH

HCPCS Level II A4215: Needle, Sterile, Any Size

HCPCS-A4216-STERILE-DILUENT-FLUSH-10ML

HCPCS Level II A4216: Sterile Diluent/Flush, 10 ml

Showing 1–10 of 633

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

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Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

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Clinical & Coding Specifications

Clinical Context

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`97597`	Debridement, open wound, first 20 sq cm or less	Debridement may be performed prior to application of `A6197` when devitalized tissue impedes healing.
`97602`	Wound(s) care, non-selective debridement; without anesthesia, for removal of devitalized tissue	Performed in wound care visits prior to dressing application when mechanical or non-selective debridement is required.
`A6209`	Foam dressing, wound cover, sterile, pad size 16 sq. in. or less	Alternative dressing supply for smaller wounds; comparison when selecting appropriate dressing size and type.
`A6212`	Composite dressing, sterile, pad size 16 sq. in. or less	Alternative sterile dressing option for wounds requiring a different dressing construct or smaller pad sizes.

Related Modifiers

7 rows

Modifier	Description	When to Use
26	Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…	- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
52	Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…	- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
53	Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…	- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
59	Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…	- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
62	Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…	- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
78	CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…	- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
80	CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…	- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…

Related Provider Taxonomies

8 rows

Taxonomy Code	Specialty	Notes
163WC0400X	Case Management Registered Nurse	Nursing Service Providers · Registered Nurse
207Q00000X	Family Medicine Physician	Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadt…
208D00000X	General Practice Physician	A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions.
133VN1401X	Pediatric Critical Care Nutrition Registered Dietitian	An individual who is a Board Certified Specialist in Pediatric Critical Care Nutrition and applies evidence-based nutrition knowledge in providing med…
163WN0002X	Neonatal Intensive Care Registered Nurse	Nursing Service Providers · Registered Nurse
1223P0300X	Periodontics	That specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the tee…
225XP0200X	Pediatric Occupational Therapist	Occupational therapists provide services to infants, toddlers and children who have or who are at risk for developmental delays or disabilities. Occup…
344600000X	Taxi	A land commercial vehicle used for the transporting of persons in non-emergency situations. The vehicle meets local, county or state regulations set f…

Related ICD-10-CM Codes

28 rows

ICD-10-CM Code	Description
E10.621	Type 1 diabetes mellitus with foot ulcer
E11.621	Type 2 diabetes mellitus with foot ulcer
I83.019	Varicose veins of right lower extremity with ulcer of unspecified site
I87.2	Venous insufficiency (chronic) (peripheral)
K11.3	Abscess of salivary gland
K92.2	Gastrointestinal hemorrhage, unspecified
L03.115	Cellulitis of right lower limb
L03.116	Cellulitis of left lower limb
L08.9	Local infection of the skin and subcutaneous tissue, unspecified
L30.9	Dermatitis, unspecified

Showing 1–10 of 28

Related Codes

HCPCS-A4206-STERILE-SYRINGE-1CC-NEEDLE

HCPCS A4206: Syringe with Needle, 1 cc or Less, Sterile

HCPCS-A4207-STERILE-2CC-SYRINGE-WITH-NEEDLE

HCPCS Level II A4207: Syringe with Needle, Sterile 2 cc

HCPCS-A4208-STERILE-3CC-SYRINGE-WITH-NEEDLE

HCPCS Level II A4208: Syringe with Needle, Sterile 3 cc

HCPCS-A4209-STERILE-SYRINGE-WITH-NEEDLE-5CC-OR-GREATER

HCPCS Level II A4209: Syringe with Needle, Sterile 5 cc or Greater

HCPCS-A4210-NEEDLE-FREE-INJECTION-DEVICE

HCPCS Level II A4210: Needle-free Injection Device, Each

HCPCS-A4211-SUPPLIES-SELF-ADMINISTERED-INJECTIONS

HCPCS Level II A4211: Supplies for Self-Administered Injections

HCPCS-A4212-NON-CORING-NEEDLE-STYLET-CATHETER-ACCESS-SUPPLY

HCPCS Level II A4212: Non-coring Needle or Stylet with/without Catheter

HCPCS-A4213-STERILE-SYRINGE-20CC-OR-GREATER

HCPCS Level II A4213: Syringe, Sterile, 20 cc or Greater, Each

HCPCS-A4215-STERILE-NEEDLE-SINGLE-EACH

HCPCS Level II A4215: Needle, Sterile, Any Size

HCPCS-A4216-STERILE-DILUENT-FLUSH-10ML

HCPCS Level II A4216: Sterile Diluent/Flush, 10 ml

Showing 1–10 of 633

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

HCPCS Level II A6197: Alginate/Fiber Gelling Sterile Wound Dressing, Large Pad

Sign up for hcpcs A6197 policy alerts

National Reimbursement Benchmarks

HCPCS Level II A6197: Alginate/Fiber Gelling Sterile Wound Dressing, Large Pad

Sign up for hcpcs A6197 policy alerts

National Reimbursement Benchmarks

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Codes

What item and size does HCPCS A6197 describe and where is it typically used?

What documentation is recommended when billing A6197?

What reimbursement benchmarks are reported for A6197?

Which modifiers and provider specialties are linked to A6197 in the content?

How does A6197 relate to common wound-care CPT and other HCPCS supply codes?

References

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Codes

What item and size does HCPCS A6197 describe and where is it typically used?

What documentation is recommended when billing A6197?

What reimbursement benchmarks are reported for A6197?

Which modifiers and provider specialties are linked to A6197 in the content?

How does A6197 relate to common wound-care CPT and other HCPCS supply codes?

References