HCPCS Code A6457

Official Description

Tubular dressing with or without elastic, any width, per linear yard

Short Descr	Tubular dressing
Coverage	Carrier Priced
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
BETOS	D1A – Medical/surgical supplies
TOS Code(s)	S – Surgical dressings or other medical supplies
Added Date	1/1/2006
Status Code	Statutory Exclusion (from MPFS, may be paid under other methodologies)
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.
OTS Orthotic	No
CCS Clinical Classification	243 - DME and supplies

A1	Dressing for one wound
A2	Dressing for two 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
KX	Requirements specified in the medical policy have been met
A3	Dressing for three wounds
A9	Dressing for nine or more wounds
GW	Service not related to the hospice patient's terminal condition
A4	Dressing for four wounds
A5	Dressing for five wounds
A7	Dressing for seven wounds
A6	Dressing for six wounds
GZ	Item or service expected to be denied as not reasonable and necessary
EY	No physician or other licensed health care provider order for this item or service
LT	Left side (used to identify procedures performed on the left side of the body)
A8	Dressing for eight wounds
CR	Catastrophe/disaster related
GA	Waiver of liability statement issued as required by payer policy, individual case
RT	Right side (used to identify procedures performed on the right 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)
GL	Medically unnecessary upgrade provided instead of non-upgraded item, no charge, no advance beneficiary notice (abn)
GP	Services delivered under an outpatient physical therapy plan of care
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.
BO	Orally administered nutrition, not by feeding tube
CG	Policy criteria applied
F6	Right hand, second digit
GO	Services delivered under an outpatient occupational therapy plan of care
GX	Notice of liability issued, voluntary under payer policy
NU	New equipment