A6213 Foam Wound Dressing HCPCS Reimbursement

HCPCS Level II code A6213 represents a sterile foam wound dressing (pad size >16 sq. in. and ≤48 sq. in.), with any size adhesive border, billed per dressing. This code is relevant nationally for clinicians, home health providers, wound care clinics, and payers because foam dressings are commonly used across a range of acute and chronic wounds to manage exudate and support healing. Accurate use of A6213 affects claims processing, coverage determinations, and cost tracking for wound care supplies.

Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise review of what A6213 denotes clinically, typical sites of service where it is supplied, common billing considerations, and where to look for payer-specific coverage rules and prior authorization requirements. The publication summarizes benchmarks and policy context relevant to supply reimbursement and coding compliance. Where input fields were not provided, such as associated taxonomies, ICD-10 diagnoses, and related codes, the report notes that those data elements are not available in the input.

Billing Code Overview

HCPCS Level II code A6213 describes a sterile foam wound dressing intended as a wound cover. The dressing is specified as a pad size greater than 16 square inches and less than or equal to 48 square inches, and it may include any size adhesive border. The descriptor denotes a single dressing, billed per each dressing supplied.

Service Type: Wound care dressing application/supply

Typical Site of Service: Outpatient clinics, outpatient wound care centers, home health visits, long-term care facilities, and other ambulatory settings where wound dressings are applied or supplied.

Clinical Context

A typical patient is an adult with a moderate-sized chronic or acute wound requiring a sterile foam dressing with an adhesive border for secure fixation. Example: a 68-year-old patient with a stage II pressure ulcer over the sacrum measuring 20 square inches being treated in an outpatient wound clinic. The clinician assesses the wound, performs cleaning and debridement as needed, measures wound dimensions, selects a foam dressing sized >16 sq. in. and ≤48 sq. in. with an adhesive border, applies the sterile dressing at the clinic visit, documents wound characteristics, dressing size and lot number, frequency of dressing changes, and follow-up plan. The supply is billed using A6213 for each dressing applied or provided to the patient. Typical sites of service include outpatient wound care clinics, hospital-based outpatient departments, skilled nursing facilities, home health visits, and emergency departments when dressing placement occurs.

Coding Specifications

Modifier	Description	When to Use
`LT`	Left side	When the dressing is specifically applied to a left-sided body location and laterality billing is required
`RT`

Taxonomy Code	Specialty	Notes
`161W00000X`	Wound Care Specialist	Commonly provides dressing selection and application in outpatient wound clinics
`207P00000X`	Physical Medicine & Rehabilitation	Manages patients with chronic wounds and coordinates wound care supplies
`208000000X`	Family Medicine	Primary care clinicians frequently apply or prescribe foam dressings in office
`282N00000X`	Nursing (Registered)	Wound dressing changes often performed by registered nurses in multiple settings

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`L89.153`	Pressure ulcer of sacral region, stage 3	Foam dressings like `A6213` are used to manage exudate and protect moderate-sized pressure ulcers
`L97.322`	Non-pressure chronic ulcer of right calf limited to breakdown of skin	Moderate-sized lower-extremity ulcers often require foam dressings with adhesive borders for secure coverage
`L03.116`	Cellulitis of left lower limb	After wound cleansing and control of infection, foam dressings may be used to protect the healing area
`S81.812A`	Open wound of left lower leg, initial encounter	Acute traumatic wounds of moderate size may be dressed with foam adhesive dressings
`E11.621`	Type 2 diabetes mellitus with foot ulcer	Diabetic foot ulcers commonly require specialized foam dressings to manage drainage and promote healing

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`97597`	Debridement, open wound, including topical application(s), wound assessment, and instruction(s) for ongoing care, first 20 sq cm or less	Often performed immediately before application of `A6213` when debridement of necrotic tissue is clinically indicated
`11042`	Debridement; subcutaneous tissue, first 20 sq cm or less	Surgical debridement that may precede placement of a foam dressing in operative or clinic settings
`99213`	Office or other outpatient visit for the evaluation and management of an established patient, low to moderate complexity	Typical visit code for the clinician encounter during which `A6213` is applied and documented
`99406`	Smoking and tobacco cessation counseling, intermediate, greater than 3 minutes up to 10 minutes	Behavioral or counseling services that may be provided during wound care visits (example ancillary service)
`99070`	Supplies and materials (except spectacles), provided by the physician over and above those usually included with the office visit	Used when billing for additional supplies related to wound care that are not separately reimbursed under `A6213`

OpenPayer

Summary & Overview

HCPCS A6213: Foam Wound Dressing, 16–48 sq. in.