HCPCS A6403: Sterile Non-Impregnated Gauze Pad >16–48 sq in - OpenPayer

Summary & Overview

HCPCS A6403: Sterile Non-Impregnated Gauze Pad >16–48 sq in

HCPCS Level II code A6403 represents a sterile, non-impregnated gauze pad (each dressing) sized greater than 16 square inches and up to 48 square inches, without an adhesive border. These larger sterile pads are commonly used in wound care for moderate-to-large surface areas requiring absorption and protection. Nationally, supplies like A6403 matter for outpatient wound management, home health services, and facility supply chains because they affect clinical supply utilization, billing consistency, and durable medical supply workflows.

Key payers examined include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The analysis addresses how A6403 is billed across common outpatient and home health sites of service and highlights payer coverage considerations.

Readers will learn the clinical context for using A6403, the typical sites of service where it is furnished, and which major payers are relevant to coverage and claims processing. Where available, the publication provides benchmarks and policy summaries related to sterile dressing supplies, notes on common modifiers used in practice, and guidance on coding accuracy to support appropriate claim submission. Data not available in the input will be identified as such.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareA6403HCPCS Level IIwound caredressing supplysterile gauzeoutpatienthome healthmedical supplies

Billing Code Overview

HCPCS Level II code A6403 describes a sterile, non-impregnated gauze pad with a pad size greater than 16 square inches and less than or equal to 48 square inches, supplied as each dressing without an adhesive border. This item is intended for wound care where a larger sterile dressing pad is required for absorption and protection.

Service Type: Wound care dressing supply

Typical Site of Service: Outpatient settings, clinic or physician office, wound care centers, and home health supply

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A typical patient scenario involves an adult or pediatric patient presenting to an outpatient wound care clinic, emergency department, or ambulatory surgery center with a clean but moderately sized open wound requiring sterile non-impregnated gauze dressing. For example, a patient with a postoperative incision dressing change, a traumatic laceration after initial hemostasis, or a chronic ulcer receiving routine dressing replacement. The clinical workflow includes wound assessment, cleansing with saline or appropriate solution, application of topical agents if indicated, placement of a sterile non‑impregnated gauze pad sized greater than 16 square inches but less than or equal to 48 square inches (A6403), securement with secondary dressings or bandage, documentation of wound appearance, and patient/caregiver instructions for follow‑up care and signs of infection. Supplies are billed per each dressing applied; use of additional services (debridement, application of topical medications, or procedural sedation) may be billed separately with appropriate CPT/ICD-10 linkage and modifiers.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when billing only the professional component of a service provided by a clinician in a facility setting when applicable to related services (not typically used for simple supply billing alone).

HCPCS A6250: Skin Sealants and Protective Moisturizers, Any Size

HCPCS-A7003-SMALL-VOLUME-NEBULIZER-ADMINISTRATION-SET

HCPCS A7003: Small-Volume Disposable Pneumatic Nebulizer Administration Set

HCPCS-A4394-OSTOMY-DEODORANT-PER-FLUID-OUNCE

HCPCS A4394: Ostomy Deodorant per Fluid Ounce

HCPCS-A4363-OSTOMY-CLAMP-REPLACEMENT

HCPCS Level II A4363: Ostomy Clamp, Replacement, Each

HCPCS-A6508-COMPRESSION-BURN-GARMENT-FOOT-TO-THIGH-CUSTOM

HCPCS A6508: Compression Burn Garment, Foot-to-Thigh, Custom Fabricated

HCPCS-A5508-DELUXE-DIABETIC-DEPTH-INLAY-OR-CUSTOM-MOLDED-SHOE

HCPCS A5508: Deluxe Diabetic Depth-Inlay or Custom-Molded Shoe

HCPCS-A4911-DIALYSIS-DRAIN-BAG-BOTTLE

HCPCS Level II A4911: Drain Bag/Bottle for Dialysis, Each

HCPCS-A7020-COUGH-STIMULATING-DEVICE-INTERFACE-REPLACEMENT

HCPCS A7020: Interface for Cough-Stimulating Device, Replacement Only

HCPCS-A4802-PROTAMINE-SULFATE-HEMODIALYSIS-50MG

HCPCS A4802: Protamine Sulfate for Hemodialysis, per 50 mg

HCPCS-A4467-BELT-STRAP-SLEEVE-GARMENT-COVERING

HCPCS A4467: Belt, Strap, Sleeve, Garment, or Covering

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Taxonomy Code	Specialty	Notes
`282N00000X`	Registered Nurse	Nurses in wound care clinics commonly perform dressing changes and billing coordination for supplies.
`207L00000X`	General Surgery	Surgeons perform procedures resulting in postoperative dressing needs sized within `A6403` range.
`208000000X`	Emergency Medicine	Emergency clinicians manage traumatic lacerations and acute wounds requiring sterile gauze dressings.
`165H00000X`	Physical Medicine & Rehabilitation	Clinicians managing chronic wounds and ulcers in outpatient wound care often oversee dressing regimens.
`364S00000X`	Wound Care Specialist	Specialty clinicians focused on complex wound management who order and apply appropriate sterile dressings.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`S01.81XA`	Laceration without foreign body of other part of head, initial encounter	Acute lacerations treated in ED or clinic that require sterile gauze dressings sized within `A6403` for protection and absorption.
`S81.811A`	Laceration without foreign body of right lower leg, initial encounter	Traumatic extremity wounds commonly dressed with larger sterile gauze pads like `A6403`.
`L97.909`	Non-pressure chronic ulcer of unspecified part of unspecified lower leg, unspecified severity	Chronic ulcers requiring routine dressing changes with sterile gauze for absorption and wound care.
`K91.89`	Other postprocedural disorders of the digestive system	Postoperative abdominal incision care may use sterile gauze pads in sizes consistent with `A6403`.
`Z48.02`	Encounter for removal of sutures and staples	Follow-up wound care encounters where dressing changes using `A6403` are performed after suture removal.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`97597`	Debridement (e.g., selective debridement, without anesthesia), open wound, first 20 sq cm or less	Often performed prior to dressing application for removal of devitalized tissue; precedes `A6403` use when debridement is indicated.
`97598`	Debridement, each additional 20 sq cm, or 2nd and each additional wound, same date	Used when larger or multiple wounds require debridement before dressing with `A6403`.
`99070`	Supplies and materials (except spectacles), provided by the physician over and above those usually included with the service	May be used to bill additional non‑standard supplies provided in conjunction with the dressing `A6403` when payer allows.
`12001`	Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities; 2.5 cm or less	Laceration repair procedures after which a sterile gauze pad such as `A6403` may be applied as the postoperative dressing.
`11042`	Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); first 20 sq cm or less	Surgical-level debridement that often precedes application of a large sterile gauze dressing `A6403`.

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