Table of content for "Sterile gauze > 48 sq in" (HCPCS A6404)
General information on the “A6404” code
HCPCS Code: A6404
Long Description: Gauze, non-impregnated, sterile, pad size more than 48 sq. in., without adhesive border, each dressing
Short Description: Sterile gauze > 48 sq in
Original information is taken from A6404 page
Pricing indicators
Pricing Indicator Code 1: 35 – Surgical dressings (price subject to floors and ceilings). Durable Medical Equipment, Prosthetics, Orthotics, Supplies And Surgical Dressings
Multiple Pricing Indicator Code A : Not applicable as HCPCS priced under one methodology
Certification and additional reference information
Coverage
Coverage: D – Special coverage instructions apply
Type of service
Berenson-Eggers Type of Service (BETOS): D1A – Medical/surgical supplies
Type Of Service 1: S – Surgical dressings or other medical supplies (eff 04/95)
Misc information
Anesthesia Base Unit Quantity: 0
Code Added Date: 19970101
Code Effective Date: 20030101
Action Code: N – No maintenance for this code