2025 HCPCS Code 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

Short Description	Sterile gauze>16 <= 48 sq in
HCPCS Coverage Code	D - Special coverage instructions apply
HCPCS Action Code	N - No maintenance for this code
HCPCS Action Effective Date	January 01, 2003
HCPCS Code Added Date	January 01, 1997
HCPCS Pricing Indicator Code	35 - Surgical dressings (price subject to floors and ceilings)
HCPCS Multiple Pricing Indicator Code	A - Not applicable as HCPCS priced under one methodology
HCPCS Coverage Issues Manual Reference Section Number
HCPCS Type Of Service Code	S - Surgical dressings or other medical supplies (eff 04/95)
HCPCS Anesthesia Base Unit Quantity	0