HCPCS Code A6203

Official Description

Composite dressing, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing

Short Descr	Composite drsg <= 16 sq in
Coverage	Special coverage instructions apply
Pricing Indicator(s)	35 – Supplies And Surgical Dressings - Surgical dressings (price subject to floors and ceilings)
MPI	A – Not applicable, as HCPCS priced under one methodology
MCM	2079
BETOS	D1A – Medical/surgical supplies
TOS Code(s)	S – Surgical dressings or other medical supplies
Added Date	1/1/1997
Status Code	Bundled/Excluded Code
Global Days	XXX - Global Concept Does Not Apply
PC/TC Indicator (26, TC)	9 - Not Applicable
Multiple Procedures (51)	9 - Concept does not apply.
Bilateral Surgery (50)	9 - Concept does not apply.
Physician Supervisions	09 - Concept does not apply.
Assistant Surgeon (80, 82)	9 - Concept does not apply.
Co-Surgeons (62)	9 - Concept does not apply.
Team Surgery (66)	9 - Concept does not apply.
Diagnostic Imaging Family	99 - Concept Does Not Apply
APC Status Indicator	Items and Services Packaged into APC Rates
MUE	0
MUE	Not applicable/unspecified.
IOM	100-02, 15, 100
OTS Orthotic	No
CCS Clinical Classification	243 - DME and supplies

A1	Dressing for one wound
A2	Dressing for two wounds
GW	Service not related to the hospice patient's terminal condition
A3	Dressing for three wounds
A4	Dressing for four wounds
A5	Dressing for five wounds
KX	Requirements specified in the medical policy have been met
GL	Medically unnecessary upgrade provided instead of non-upgraded item, no charge, no advance beneficiary notice (abn)
AY	Item or service furnished to an esrd patient that is not for the treatment of esrd
A6	Dressing for six wounds
A8	Dressing for eight wounds
RT	Right side (used to identify procedures performed on the right side of the body)
A9	Dressing for nine or more wounds
AW	Item furnished in conjunction with a surgical dressing
LT	Left side (used to identify procedures performed on the left side of the body)
CC	Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed)
79	Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.)
A7	Dressing for seven wounds
GY	Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit
59	Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25.
GA	Waiver of liability statement issued as required by payer policy, individual case
GV	Attending physician not employed or paid under arrangement by the patient's hospice provider
GZ	Item or service expected to be denied as not reasonable and necessary
58	Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78.
GP	Services delivered under an outpatient physical therapy plan of care