A6207 Contact Layer Dressing Reimbursement | OpenPayer

Summary & Overview

HCPCS A6207: Sterile Contact Layer Dressing, 17–48 sq. in.

HCPCS Level II code A6207 represents a sterile contact layer dressing sized greater than 16 square inches and up to 48 square inches, billed per dressing. Such contact layers are commonly used in wound management to protect the wound surface, support a moist healing environment, and serve as an interface beneath secondary dressings. Nationally, this code matters because dressing supplies account for a substantial portion of wound-care consumable spending across outpatient, home health, long-term care, and hospital outpatient settings. Coverage and reimbursement policies for wound dressings influence access to appropriate wound care and can affect overall episode costs for chronic wounds.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of what A6207 denotes, the typical clinical settings where the dressing is used, and the payer landscape addressed in the publication. The full analysis includes benchmark pricing for comparable dressings, payer policy variations affecting prior authorization and coverage, coding and billing guidance for supply-line items, and clinical context describing when contact layer dressings are selected relative to other wound products. Data not available in the input is explicitly noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareA6207HCPCS Level IIwound caredressing supplycontact layer dressingoutpatienthome healthdurable medical supplymedical billing

Billing Code Overview

HCPCS Level II code A6207 describes a sterile contact layer dressing measuring more than 16 square inches but less than or equal to 48 square inches, billed per dressing. This product is intended as a contact layer placed directly over a wound bed to protect tissue, maintain a moist wound environment, and act as an interface between the wound and secondary dressings.

Service type: Wound care dressing supply

Typical site of service: Outpatient wound care clinics, hospital outpatient departments, long-term care facilities, and home health settings where topical wound management is provided.

Clinical & Coding Specifications

Clinical Context

A typical patient is an adult with a partial-thickness or superficial full-thickness wound (for example, a donor site, abrasion, postoperative surgical incision with fragile epithelializing tissue, or chronic venous/diabetic ulcer) requiring a sterile contact layer dressing sized >16 sq. in. and ≤48 sq. in. The contact layer A6207 is applied in an outpatient wound clinic, hospital bedside, skilled nursing facility, or home health visit by a wound care nurse, physician assistant, or physician. The clinical workflow includes wound assessment (size, depth, exudate, infection signs), cleansing and debridement as indicated, application of A6207 directly over the wound bed to protect fragile tissue and allow exudate passage to an absorbent secondary dressing, securing the dressing, and documenting dressing type, size, location, and frequency of change. Typical follow-up occurs within 24–72 hours or per wound care protocol to reassess healing and replace the contact layer as needed.

Coding Specifications

Modifier	Description	When to Use
`00`	Default/No modifier	Use when no modifier applies to the service.

HCPCS A4431: Urinary Ostomy Pouch with Faucet-Type Tap, One-Piece

HCPCS-A5121-SKIN-BARRIER-SOLID-6X6

HCPCS A5121: Skin Barrier, Solid, 6 x 6 or Equivalent

HCPCS-A4663-BLOOD-PRESSURE-CUFF-ONLY

HCPCS A4663: Blood Pressure Cuff Only

HCPCS-A4362-SKIN-BARRIER-SOLID-4X4

HCPCS A4362: Skin Barrier, Solid 4x4

HCPCS-A4300-IMPLANTABLE-EXTERNAL-ACCESS-CATHETER

HCPCS A4300: Implantable External-Access Catheter

HCPCS-A6529-GRADIENT-COMPRESSION-NIGHTTIME-BRA-CUSTOM

HCPCS A6529: Gradient Compression Bra, Nighttime, Custom

HCPCS-A4342-INTRAURETHRAL-DRAINAGE-ACCESSORY-VALVE-REPLACEMENT

HCPCS A4342: Intraurethral Drainage Accessory with Valve, Replacement Only

HCPCS-A6605-GRADIENT-COMPRESSION-FOAM-BANDAGING-SUPPLY-PER-YARD

HCPCS Level II A6605: Gradient Compression Padded Foam Bandaging, per Linear Yard

HCPCS-A6236-HYDROCOLLOID-DRESSING-LARGE-WOUND-COVER

HCPCS A6236: Hydrocolloid Dressing, Large Sterile Wound Cover

HCPCS-A4563-RECTAL-CONTROL-SYSTEM-VAGINAL-INSERTION-LONG-TERM

HCPCS A4563: Rectal Control System for Vaginal Insertion, Long-Term Use

Showing 1–10 of 633

22

Taxonomy Code	Specialty	Notes
`170300000X`	Wound Care Specialist (Physician)	Physicians specializing in complex wound management who order and oversee dressing use.
`363L00000X`	Nurse Practitioner	NPs often perform wound assessments and dressing applications in outpatient and home settings.
`363A00000X`	Physician Assistant	PAs frequently provide wound care interventions and document supply use.
`251B00000X`	Registered Nurse (Wound Care)	Wound care nurses perform dressing changes and product application at bedside or clinic.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`L89.309`	Pressure ulcer of sacral region, stage 3, unspecified	Pressure ulcers commonly require contact layer dressings to protect granulating tissue and manage exudate.
`L97.209`	Non-pressure chronic ulcer of unspecified part of lower leg, unspecified severity	Venous or neuropathic ulcers of the lower leg frequently use contact layers as a wound contact interface.
`E11.621`	Type 2 diabetes mellitus with foot ulcer	Diabetic foot ulcers often receive contact layers under secondary absorptive dressings as part of wound care.
`S81.001A`	Open wound of right knee, initial encounter	Traumatic open wounds may be managed with contact layers to protect healing tissue.
`Z48.00`	Encounter for change or removal of surgical wound dressing	Postoperative dressing changes commonly involve sterile contact layer products like `A6207`.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`11042`	Debridement, subcutaneous tissue (e.g., for wound preparation), first 20 sq cm or less	Debridement is often performed prior to application of a contact layer dressing to prepare the wound bed.
`11043`	Debridement, muscle and/or fascia, first 20 sq cm or less	Deeper debridement that may precede placement of a contact layer when indicated.
`97597`	Debridement (e.g., selective debridement), without anesthesia, open wound(s), first 20 sq cm or less	Selective debridement by a clinician in outpatient or home settings before applying `A6207`.
`99213`	Office or other outpatient visit for the evaluation and management of an established patient, typically 15 minutes	Common visit level for wound assessment and dressing application in clinic.
`99070`	Supplies and materials (except spectacles), used by the physician or other qualified healthcare professional, not included with a procedure or service	May be used for billing additional non-covered supplies when payer policy allows; `A6207` is a HCPCS supply line item typically billed separately.

OpenPayer