2016 WOUND CARE SUPPLIES
POCKET CODING GUIDE
HCPCS codes are billed to private payers and Medicare DME MACs for wound care products. Coverage for these products is at
the discretion of the individual carrier in alignment with the patient’s benefits.
HCPCS
CODE1
HCPCS DESCRIPTION
MEDTRONIC PRODUCT(S)
OPTIONS
ALCOHOL WIPES
A4245
A5120
Curity™ Alcohol Preps Sterile
• Medium 2-ply
Webcol™ Alcohol Preps
• Large 1-ply and 2-ply
• Medium 2-ply
Webcol™ Skin Barrier Wipes
• Large 2-ply Wipes
Webcol™ Adhesive Remover Wipes
• Large 2-ply Wipes
Alcohol wipes, per box
Skin barrier, wipes or swabs, each
ALGINATE DRESSINGS
A6196
Alginate dressing ≤ 16 sq in
Kendall™ Calcium Alginate Dressings Sterile 1s
• Various sizes ≤ 16 sq in
A6197
Alginate dressing > 16 ≤ 48 sq in
Kendall™ Calcium Alginate Dressings Sterile 1s
• 4" x 5.5"
• 4" x 8"
A6198
Alginate dressing > 48 sq in
Kendall™ Calcium Alginate Dressings Sterile 1s
• 6" x 10"
• 12" x 24"
A6199
Alginate dressing wound filler
Kendall™ Calcium Alginate Dressings Sterile 1s
• Various Rope sizes
Telfa™ AMD Antimicrobial Island Dressings Sterile 1s
• 4” x 5”
• 4” x 8”
Telfa™ Island Dressings Sterile 1s
• 2” x 3”
Telfa™ Plus Island Dressings Sterile 1s
• 4” x 6”
NON ADHERENT DRESSINGS AND GAUZE SPONGES
A6203
Composite dressing, sterile, pad size ≤16 sq in
A6204
Composite dressing, sterile, pad size >16 sq
in but ≤48 sq in, with any size adhesive border,
each dressing
Telfa™ Plus Island Dressings Sterile 1s
• 6" x 7"
A6205
Composite dressing, sterile, pad size >48 sq in,
with any size adhesive border, each dressing
Telfa™ Plus Island Dressings Sterile 1s
• 6” x 10”
• 8” x 8”
A6216
Gauze, non-impregnated, sterile, pad size >16
≤48 sq in with any size adhesive border
Curity™ Gauze Sponges Kerlix™ Gauze Sponges
Dermacea™ Gauze Sponges – 8-ply and 12-ply
available
• 2” x 2”
• 3” x 3”
• 4” x 4”
A6219
Gauze, ≤16 sq in w/border
Telfa™ Island Dressings Sterile 1s
• 4" x 4"
Telfa™ Island Dressings Sterile 1s
•
•
•
•
•
Curity™ AMD Antimicrobial Gauze Sponges
• 2” x 2” 8-ply
• 4” x 4” 12-ply
Telfa™ AMD Antimicrobial Pads Sterile 1s
• 3" x 4"
Excilon™ AMD Antimicrobial Sponges
• Drain Sponge 4” x 4”
• I.V. Sponge 2” x 2"
Telfa™ AMD Antimicrobial Pads Sterile 1s
• 3" x 8"
A6220
A6222
A6223
Gauze, non-impregnated, sterile, pad size >16
≤48 sq in with any size adhesive border
Gauze, impregnated with other than water,
normal saline, or hydrogel, sterile, pad size ≤16
in no w/sal w/o border
Gauze, impregnated , sterile, pad size >16 ≤48
no w/sal w/o border
4” x 5”
4” x 8”
4” x 10”
4” x 14”
6” x 6"
HCPCS
CODE1
HCPCS DESCRIPTION
MEDTRONIC PRODUCT(S)
OPTIONS
FOAM DRESSINGS
A6209
Foam dressing, wound cover, sterile, pad size
≤16 sq in w/o border
Kendall™ Foam Dressings
Kendall™ AMD Antimicrobial Foam Dressings
• Various sizes ≤ 16 sq in
• Fenestrated 3.5" x 3"
A6210
Foam dressing, wound cover, sterile, pad size
>16 ≤48 sq in w/o border
Kendall™ Foam Dressings
Kendall™ AMD Antimicrobial Foam Dressings
• Various sizes
A6211
Foam dressing, wound cover, sterile, pad size >
48 sq in w/o border
Kendall™ Foam Dressing
Kendall™ AMD Antimicrobial Foam Dressings
• 8" x 8"
A6212
Foam dressing, wound cover, sterile, pad size
≤16 sq in w/border
Kendall™ Foam Island Dressings
Kendall™ AMD Antimicrobial Foam Border Dressings
Kendall™ Foam Border Gentle Adhesion Dressings
• Various sizes
A6213
Foam dressing, wound cover, sterile, pad size
>16 ≤48 sq in w/border
Kendall™ Foam Island Dressings
Kendall™ AMD Antimicrobial Foam Border Dressings
Kendall™ Foam Border Gentle Adhesion Dressings
• 6" x 6" available in all
A4221
Supplies for maintenance of drug infusion
catheter, per week (list drug separately)
Kendall™ AMD Antimicrobial Foam Discs
• 1" Diameter, 4 mm hole
• 1" Diameter, 7 mm hole
Kendall™ Transparent Film Dressing Sterile 1s
• 1 ½" x 1 ½"
Kendall™ Window Transparent Film Dressing Sterile
1s
• 1.75" x 1.75"
• 2.375" x 2.75"
Kendall™ Transparent Film Dressing Sterile 1s
• 4" x 4 ¾"
• 4" x 8"
• 6" x 8"
Kendall™ Window Transparent Film Dressing Sterile
1s
• 4" x 4.75"
• 6" x 8"
• 4" x 10"
Kendall™ Transparent Film Dressing Sterile 1s
• 8" x 10"
Kendall™ Window Transparent Film Dressing Sterile
1s
• 8" x 12"
Curity™ AMD Antimicrobial Packing Strips
• ¼” x 1 yard
• ½” x 1 yard
• 1” x 1 yard
Kerlix™ AMD Antimicrobial Bandage Roll
• 4.5" x 4.1 yards
Excilon™ Sponges and Dermacea™ Sponges
• Drain Sponge 4” x 4”
• I.V. Sponge 2” x 2”
TRANSPARENT FILM DRESSINGS
A6257
A6258
A6259
Transparent film, sterile, 16 sq in or less, each
dressing
Transparent film, sterile, > 16 sq in, but ≤ 48 sq in,
each dressing
Transparent film, sterile, > 48 sq in, each
dressing
PACKING STRIPS AND BANDAGE ROLLS
A6266
Gauze, impregnated, other than water, normal
saline, or zinc paste, sterile, any width, per linear
yard
DRAIN SPONGES AND I.V. SPONGES
A6402
Gauze, non-impregnated, sterile, pad size ≥ 16
sq in, without adhesive border, each dressing
BANDAGE ROLLS
A6445
Conforming bandage, non-elastic, knitted /
woven, sterile, width < 3"
Dermacea™ Gauze Fluff Roll Kerlix™ Bandage Roll
• 2" x 3 yards
A6446
Conforming bandage, non-elastic, knitted/
woven, sterile, width ≥3 <5/yd
Dermacea ™Gauze Fluff Roll Kerlix™ Bandage Roll
• 4" x 4 yards
Curity™ Stretch Bandage
• 4" x 4.1 yards
A6449
Light compression bandage, elastic, knitted/
woven, width ≥ 3" and < 5"
Dermacea™ Stretch Bandage
• 4” x 4 yards
Curity™ Elastic Bandage with Removable Clips
• 4” x 4.5 yards
1. CMS 2016 Alpha-Numeric HCPCS File
The information contained in this guide is for educational purposes only and is not intended to serve as reimbursement advice. The information herein is taken from the materials published by the Centers for Medicare and Medicaid Services and the American Medical Association and may be helpful to providers in staying up to date on coding and
billing of services. This information is subject to change, and cannot guarantee coverage or reimbursement. Medtronic makes no other representations as to selecting codes
for procedures or compliance with any other billing protocols or prerequisites. As with all claims, providers are responsible for exercising their independent clinical judgment in
selecting the codes that most accurately reflect the patient’s condition and procedures performed for a patient and to consult with each patient’s health plan for appropriate
reporting of each procedure. Providers should refer to current, complete, and authoritative publications such as AMA HCPCS Level II Code publication or insurer policies for
selecting codes based on the care rendered to an individual patient, and may wish to contact individual carriers, fiscal intermediaries, or other third-party payers as needed.
© 2016 Medtronic. All rights reserved. Medtronic, Medtronic logo and Further, Together are trademarks of Medtronic. All other brands are trademarks of a Medtronic company.
02/2016 H9258
For more information, contact the Medtronic Reimbursement Hotline (877) 278-7482.
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