| Code | Description | States | Median rate |
|---|---|---|---|
| A6010 | Collagen based wound filler, dry form, sterile, per gram of collagen | 38 | $35.31 |
| A6011 | Collagen based wound filler, gel/paste, per gram of collagen | 37 | $2.60 |
| A6021 | Collagen dressing, sterile, size 16 sq. in. or less, each | 41 | $24.20 |
| A6022 | Collagen dressing, sterile, size more than 16 sq. in. but less than or equal to 48 sq. in., each | 40 | $23.42 |
| A6023 | Collagen dressing, sterile, size more than 48 sq. in., each | 40 | $207.12 |
| A6024 | Collagen dressing wound filler, sterile, per 6 inches | 39 | $7.05 |
| A6025 | Gel sheet for dermal or epidermal application, (e.g., silicone, hydrogel, other), each | 12 | $21.56 |
| A6154 | Wound pouch, each | 35 | $16.38 |
| A6196 | Alginate or other fiber gelling dressing, wound cover, sterile, pad size 16 sq. in. or less, each dressing | 44 | $8.39 |
| A6197 | Alginate or other fiber gelling dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., each dressing | 43 | $18.75 |
| A6198 | Alginate or other fiber gelling dressing, wound cover, sterile, pad size more than 48 sq. in., each dressing | 26 | $19.11 |
| A6199 | Alginate or other fiber gelling dressing, wound filler, sterile, per 6 inches | 41 | $6.02 |
| A6203 | Composite dressing, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing | 43 | $3.84 |
| A6204 | Composite dressing, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing | 42 | $7.09 |
| A6205 | Composite dressing, sterile, pad size more than 48 sq. in., with any size adhesive border, each dressing | 26 | $5.58 |
| A6206 | Contact layer, sterile, 16 sq. in. or less, each dressing | 29 | $2.74 |
| A6207 | Contact layer, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing | 42 | $8.38 |
| A6208 | Contact layer, sterile, more than 48 sq. in., each dressing | 24 | $8.27 |
| A6209 | Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing | 43 | $8.52 |
| A6210 | Foam dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing | 42 | $21.57 |
| A6211 | Foam dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing | 42 | $33.49 |
| A6212 | Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing | 42 | $10.62 |
| A6213 | Foam dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing | 35 | $9.87 |
| A6214 | Foam dressing, wound cover, sterile, pad size more than 48 sq. in., with any size adhesive border, each dressing | 39 | $11.73 |
| A6215 | Foam dressing, wound filler, sterile, per gram | 18 | $1.57 |
| A6216 | Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing | 43 | $0.05 |
| A6217 | Gauze, non-impregnated, non-sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing | 28 | $0.33 |
| A6218 | Gauze, non-impregnated, non-sterile, pad size more than 48 sq. in., without adhesive border, each dressing | 26 | $0.57 |
| A6219 | Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing | 42 | $1.09 |
| A6220 | Gauze, non-impregnated, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing | 41 | $2.86 |
| A6221 | Gauze, non-impregnated, sterile, pad size more than 48 sq. in., with any size adhesive border, each dressing | 21 | $2.38 |
| A6222 | Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing | 42 | $2.39 |
| A6223 | Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size more than 16 sq. in., but less than or equal to 48 sq. in., without adhesive border, each dressing | 42 | $2.73 |
| A6224 | Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size more than 48 sq. in., without adhesive border, each dressing | 41 | $3.99 |
| A6228 | Gauze, impregnated, water or normal saline, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing | 18 | $1.93 |
| A6229 | Gauze, impregnated, water or normal saline, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing | 38 | $3.94 |
| A6230 | Gauze, impregnated, water or normal saline, sterile, pad size more than 48 sq. in., without adhesive border, each dressing | 18 | $2.31 |
| A6231 | Gauze, impregnated, hydrogel, for direct wound contact, sterile, pad size 16 sq. in. or less, each dressing | 37 | $5.40 |
| A6232 | Gauze, impregnated, hydrogel, for direct wound contact, sterile, pad size greater than 16 sq. in., but less than or equal to 48 sq. in., each dressing | 38 | $7.86 |
| A6233 | Gauze, impregnated, hydrogel, for direct wound contact, sterile, pad size more than 48 sq. in., each dressing | 35 | $21.88 |
| A6234 | Hydrocolloid dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing | 43 | $7.46 |
| A6235 | Hydrocolloid dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing | 42 | $18.30 |
| A6236 | Hydrocolloid dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing | 43 | $31.06 |
| A6237 | Hydrocolloid dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing | 42 | $8.62 |
| A6238 | Hydrocolloid dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing | 42 | $25.60 |
| A6239 | Hydrocolloid dressing, wound cover, sterile, pad size more than 48 sq. in., with any size adhesive border, each dressing | 18 | $18.41 |
| A6240 | Hydrocolloid dressing, wound filler, paste, sterile, per ounce | 41 | $13.54 |
| A6241 | Hydrocolloid dressing, wound filler, dry form, sterile, per gram | 41 | $2.89 |
| A6242 | Hydrogel dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing | 43 | $6.77 |
| A6243 | Hydrogel dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing | 41 | $13.38 |
| A6244 | Hydrogel dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing | 41 | $44.79 |
| A6245 | Hydrogel dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing | 41 | $8.03 |
| A6246 | Hydrogel dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing | 42 | $11.33 |
| A6247 | Hydrogel dressing, wound cover, sterile, pad size more than 48 sq. in., with any size adhesive border, each dressing | 40 | $27.11 |
| A6248 | Hydrogel dressing, wound filler, gel, per fluid ounce | 43 | $17.96 |
| A6250 | Skin sealants, protectants, moisturizers, ointments, any type, any size | 20 | $3.69 |
| A6251 | Specialty absorptive dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing | 42 | $2.27 |
| A6252 | Specialty absorptive dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing | 42 | $3.68 |
| A6253 | Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing | 42 | $7.16 |
| A6254 | Specialty absorptive dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing | 41 | $1.35 |
| A6255 | Specialty absorptive dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing | 42 | $3.42 |
| A6256 | Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., with any size adhesive border, each dressing | 20 | $3.39 |
| A6257 | Transparent film, sterile, 16 sq. in. or less, each dressing | 43 | $1.70 |
| A6258 | Transparent film, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing | 42 | $4.84 |
| A6259 | Transparent film, sterile, more than 48 sq. in., each dressing | 43 | $12.47 |
| A6260 | Wound cleansers, any type, any size | 17 | $7.68 |
| A6261 | Wound filler, gel/paste, per fluid ounce, not otherwise specified | 18 | $3.71 |
| A6262 | Wound filler, dry form, per gram, not otherwise specified | 17 | $1.00 |
| A6266 | Gauze, impregnated, other than water, normal saline, or zinc paste, sterile, any width, per linear yard | 42 | $2.18 |
| A6402 | Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing | 41 | $0.13 |
| A6403 | Gauze, non-impregnated, sterile, pad size more than 16 sq. in. less than or equal to 48 sq. in., without adhesive border, each dressing | 43 | $0.47 |
| A6404 | Gauze, non-impregnated, sterile, pad size more than 48 sq. in., without adhesive border, each dressing | 26 | $0.64 |
| A6407 | Packing strips, non-impregnated, sterile, up to 2 inches in width, per linear yard | 38 | $2.15 |
| A6410 | Eye pad, sterile, each | 34 | $0.44 |
| A6411 | Eye pad, non-sterile, each | 18 | $0.26 |
| A6412 | Eye patch, occlusive, each | 18 | $0.49 |
| A6441 | Padding bandage, non-elastic, non-woven/non-knitted, width greater than or equal to three inches and less than five inches, per yard | 39 | $0.78 |
| A6442 | Conforming bandage, non-elastic, knitted/woven, non-sterile, width less than three inches, per yard | 39 | $0.19 |
| A6443 | Conforming bandage, non-elastic, knitted/woven, non-sterile, width greater than or equal to three inches and less than five inches, per yard | 40 | $0.32 |
| A6444 | Conforming bandage, non-elastic, knitted/woven, non-sterile, width greater than or equal to 5 inches, per yard | 40 | $0.64 |
| A6445 | Conforming bandage, non-elastic, knitted/woven, sterile, width less than three inches, per yard | 36 | $0.36 |
| A6446 | Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard | 42 | $0.45 |
| A6447 | Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to five inches, per yard | 39 | $0.78 |
| A6448 | Light compression bandage, elastic, knitted/woven, width less than three inches, per yard | 39 | $1.31 |
| A6449 | Light compression bandage, elastic, knitted/woven, width greater than or equal to three inches and less than five inches, per yard | 40 | $1.97 |
| A6450 | Light compression bandage, elastic, knitted/woven, width greater than or equal to five inches, per yard | 37 | $2.00 |
| A6451 | Moderate compression bandage, elastic, knitted/woven, load resistance of 1.25 to 1.34 foot pounds at 50% maximum stretch, width greater than or equal to three inches and less than five inches, per yard | 31 | $2.05 |
| A6452 | High compression bandage, elastic, knitted/woven, load resistance greater than or equal to 1.35 foot pounds at 50% maximum stretch, width greater than or equal to three inches and less than five inches, per yard | 39 | $6.72 |
| A6453 | Self-adherent bandage, elastic, non-knitted/non-woven, width less than three inches, per yard | 36 | $0.72 |
| A6454 | Self-adherent bandage, elastic, non-knitted/non-woven, width greater than or equal to three inches and less than five inches, per yard | 37 | $0.91 |
| A6455 | Self-adherent bandage, elastic, non-knitted/non-woven, width greater than or equal to five inches, per yard | 36 | $1.60 |
| A6456 | Zinc paste impregnated bandage, non-elastic, knitted/woven, width greater than or equal to three inches and less than five inches, per yard | 39 | $1.46 |
| A6457 | Tubular dressing with or without elastic, any width, per linear yard | 39 | $1.30 |
| A6520 | Gradient compression garment, glove, padded, for nighttime use, each | 23 | $116.36 |
| A6521 | Gradient compression garment, glove, padded, for nighttime use, custom, each | 22 | $461.68 |
| A6522 | Gradient compression garment, arm, padded, for nighttime use, each | 24 | $279.63 |
| A6523 | Gradient compression garment, arm, padded, for nighttime use, custom, each | 22 | $670.80 |
| A6524 | Gradient compression garment, lower leg and foot, padded, for nighttime use, each | 24 | $348.87 |
| A6525 | Gradient compression garment, lower leg and foot, padded, for nighttime use, custom, each | 23 | $704.31 |
| A6526 | Gradient compression garment, full leg and foot, padded, for nighttime use, each | 25 | $623.75 |
| A6527 | Gradient compression garment, full leg and foot, padded, for nighttime use, custom, each | 23 | $1,159.85 |
| A6528 | Gradient compression garment, bra, for nighttime use, each | 26 | $583.12 |
| A6529 | Gradient compression garment, bra, for nighttime use, custom, each | 23 | $958.35 |
| A6530 | Gradient compression stocking, below knee, 18-30 mmhg, each | 35 | $31.26 |
| A6531 | Gradient compression stocking, below knee, 30-40 mmhg, used as a surgical dressing, each | 35 | $47.83 |
| A6532 | Gradient compression stocking, below knee, 40-50 mmhg, used as a surgical dressing, each | 34 | $69.50 |
| A6533 | Gradient compression stocking, thigh length, 18-30 mmhg, each | 36 | $43.89 |
| A6534 | Gradient compression stocking, thigh length, 30-40 mmhg, each | 32 | $52.16 |
| A6535 | Gradient compression stocking, thigh length, 40 mmhg or greater, each | 31 | $61.31 |
| A6536 | Gradient compression stocking, full length/chap style, 18-30 mmhg, each | 31 | $61.57 |
| A6537 | Gradient compression stocking, full length/chap style, 30-40 mmhg, each | 31 | $80.13 |
| A6538 | Gradient compression stocking, full length/chap style, 40 mmhg or greater, each | 31 | $92.02 |
| A6539 | Gradient compression stocking, waist length, 18-30 mmhg, each | 31 | $81.47 |
| A6540 | Gradient compression stocking, waist length, 30-40 mmhg, each | 30 | $97.14 |
| A6541 | Gradient compression stocking, waist length, 40 mmhg or greater, each | 31 | $115.07 |
| A6544 | Gradient compression stocking, garter belt | 25 | $27.36 |
| A6545 | Gradient compression wrap, non-elastic, below knee, 30-50 mmhg, used as a surgical dressing, each | 27 | $96.03 |
| A6548 | Accessory to custom gradient compression garment, silicone band, any size | 11 | $20.86 |
| A6550 | Wound care set, for negative pressure wound therapy electrical pump, includes all supplies and accessories | 38 | $26.63 |
| A6552 | Gradient compression stocking, below knee, 30-40 mmhg, each | 29 | $49.17 |
| A6553 | Gradient compression stocking, below knee, 30-40 mmhg, custom, each | 26 | $201.17 |
| A6554 | Gradient compression stocking, below knee, 40 mmhg or greater, each | 29 | $67.63 |
| A6555 | Gradient compression stocking, below knee, 40 mmhg or greater, custom, each | 26 | $201.17 |
| A6556 | Gradient compression stocking, thigh length, 18-30 mmhg, custom, each | 25 | $277.46 |
| A6557 | Gradient compression stocking, thigh length, 30-40 mmhg, custom, each | 26 | $277.46 |
| A6558 | Gradient compression stocking, thigh length, 40 mmhg or greater, custom, each | 25 | $286.33 |
| A6562 | Gradient compression stocking, waist length, 18-30 mmhg, custom, each | 26 | $902.29 |
| A6563 | Gradient compression stocking, waist length, 30-40 mmhg, custom, each | 26 | $902.29 |
| A6564 | Gradient compression stocking, waist length, 40 mmhg or greater, custom, each | 26 | $971.96 |
| A6565 | Gradient compression gauntlet, custom, each | 24 | $157.91 |
| A6566 | Gradient compression garment, neck/head, each | 24 | $229.28 |
| A6567 | Gradient compression garment, neck/head, custom, each | 22 | $736.50 |
| A6568 | Gradient compression garment, torso and shoulder, each | 26 | $141.32 |
| A6569 | Gradient compression garment, torso/shoulder, custom, each | 24 | $852.07 |
| A6570 | Gradient compression garment, genital region, each | 25 | $99.12 |
| A6571 | Gradient compression garment, genital region, custom, each | 23 | $619.62 |
| A6572 | Gradient compression garment, toe caps, each | 24 | $94.60 |
| A6573 | Gradient compression garment, toe caps, custom, each | 24 | $224.49 |
| A6574 | Gradient compression arm sleeve and glove combination, custom, each | 26 | $282.57 |
| A6575 | Gradient compression arm sleeve and glove combination, each | 26 | $90.90 |
| A6576 | Gradient compression arm sleeve, custom, medium weight, each | 25 | $174.54 |
| A6577 | Gradient compression arm sleeve, custom, heavy weight, each | 25 | $144.46 |
| A6578 | Gradient compression arm sleeve, each | 27 | $68.74 |
| A6579 | Gradient compression glove, custom, medium weight, each | 24 | $281.93 |
| A6580 | Gradient compression glove, custom, heavy weight, each | 24 | $279.86 |
| A6581 | Gradient compression glove, each | 25 | $67.16 |
| A6582 | Gradient compression gauntlet, each | 25 | $43.81 |
| A6583 | Gradient compression wrap with adjustable straps, below knee, each | 27 | $138.36 |
| A6585 | Gradient compression wrap with adjustable straps, above knee, each | 23 | $172.55 |
| A6586 | Gradient compression wrap with adjustable straps, full leg, each | 23 | $508.36 |
| A6587 | Gradient compression wrap with adjustable straps, foot, each | 24 | $65.85 |
| A6588 | Gradient compression wrap with adjustable straps, arm, each | 24 | $219.48 |
| A6589 | Gradient pressure wrap with adjustable straps, bra, each | 25 | $84.24 |
| A6590 | External urinary catheters; disposable, with wicking material, for use with suction pump, per month | 14 | $356.88 |
| A6591 | External urinary catheter; non-disposable, for use with suction pump, per month | 12 | $75.42 |
| A6594 | Gradient compression bandaging supply, bandage liner, lower extremity, any size or length, each | 24 | $31.55 |
| A6595 | Gradient compression bandaging supply, bandage liner, upper extremity, any size or length, each | 24 | $31.03 |
| A6596 | Gradient compression bandaging supply, conforming gauze, per linear yard, any width, each | 24 | $0.16 |
| A6597 | Gradient compression bandage roll, elastic long stretch, linear yard, any width, each | 25 | $1.37 |
| A6598 | Gradient compression bandage roll, elastic medium stretch, per linear yard, any width, each | 23 | $0.65 |
| A6599 | Gradient compression bandage roll, inelastic short stretch, per linear yard, any width, each | 25 | $1.50 |
| A6600 | Gradient compression bandaging supply, high density foam sheet, per 250 square centimeters, each | 25 | $2.71 |
| A6601 | Gradient compression bandaging supply, high density foam pad, any size or shape, each | 25 | $3.05 |
| A6602 | Gradient compression bandaging supply, high density foam roll for bandage, per linear yard, any width, each | 25 | $4.44 |
| A6603 | Gradient compression bandaging supply, low density channel foam sheet, per 250 square centimeters, each | 25 | $2.08 |
| A6604 | Gradient compression bandaging supply, low density flat foam sheet, per 250 square centimeters, each | 24 | $1.22 |
| A6605 | Gradient compression bandaging supply, padded foam, per linear yard, any width, each | 25 | $1.38 |
| A6606 | Gradient compression bandaging supply, padded textile, per linear yard, any width, each | 25 | $4.12 |
| A6607 | Gradient compression bandaging supply, tubular protective absorption layer, per linear yard, any width, each | 24 | $1.11 |
| A6608 | Gradient compression bandaging supply, tubular protective absorption padded layer, per linear yard, any width, each | 25 | $4.60 |
| A6610 | Gradient compression stocking, below knee, 18-30 mmhg, custom, each | 24 | $203.74 |
Published Medicaid fee-for-service schedule amounts, not a coverage or eligibility guarantee. Managed-care plan rates can differ. Where no prior-authorization flag is shown, the state does not publish one. Descriptions are ProviderSignal's own plain-language labels or public-domain CMS text.