A6242 HCPCS code: Hydrogel dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing
A6242 is the HCPCS Level II code for hydrogel dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing. The 2026 Medicare DMEPOS fee schedule pays $8.63 to $10.39 depending on the state. Its Medicare coverage code is D (Special coverage instructions apply): Medicare covers it when its national or local coverage criteria are met. Medicare volume fell 75% from 2022 to 2024 (206,402 to 51,451 services). In 2024, 65 suppliers billed Medicare for A6242 (purchases), serving 1,596 beneficiaries; Texas, New York, Illinois accounted for 30% of services. Its average fee ranks 18 of 41 A62 codes (family range $0.05–$56.30).
Code details
| Field | Value |
|---|---|
| Section | A codes — Transportation, medical/surgical supplies and miscellaneous |
| Coverage code | D — Special coverage instructions apply |
| Pricing indicator | 35 — DMEPOS: surgical dressings |
| BETOS category | D1A — Medical/surgical supplies |
| Added | 1997-01-01 |
| Last action effective | 2009-01-01 |
2026 Medicare DMEPOS fee schedule for A6242
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $8.63 | $10.39 | $8.63 | $7.34 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $8.73 | — |
| AL | — | $8.63 | — |
| AR | — | $8.63 | — |
| AZ | — | $8.63 | — |
| CA | — | $8.63 | — |
| CO | — | $8.63 | — |
| CT | — | $8.63 | — |
| DC | — | $8.63 | — |
| DE | — | $8.63 | — |
| FL | — | $8.63 | — |
| GA | — | $8.63 | — |
| HI | — | $9.34 | — |
| IA | — | $8.63 | — |
| ID | — | $8.63 | — |
| IL | — | $8.63 | — |
| IN | — | $8.63 | — |
| KS | — | $8.63 | — |
| KY | — | $8.63 | — |
| LA | — | $8.63 | — |
| MA | — | $8.63 | — |
| MD | — | $8.63 | — |
| ME | — | $8.63 | — |
| MI | — | $8.63 | — |
| MN | — | $8.63 | — |
| MO | — | $8.63 | — |
| MS | — | $8.63 | — |
| MT | — | $8.63 | — |
| NC | — | $8.63 | — |
| ND | — | $8.63 | — |
| NE | — | $8.63 | — |
| NH | — | $8.63 | — |
| NJ | — | $8.63 | — |
| NM | — | $8.63 | — |
| NV | — | $8.63 | — |
| NY | — | $8.63 | — |
| OH | — | $8.63 | — |
| OK | — | $8.63 | — |
| OR | — | $8.63 | — |
| PA | — | $8.63 | — |
| PR | — | $10.39 | — |
| RI | — | $8.63 | — |
| SC | — | $8.63 | — |
| SD | — | $8.63 | — |
| TN | — | $8.63 | — |
| TX | — | $8.63 | — |
| UT | — | $8.63 | — |
| VA | — | $8.63 | — |
| VI | — | $8.63 | — |
| VT | — | $8.63 | — |
| WA | — | $8.63 | — |
| WI | — | $8.63 | — |
| WV | — | $8.63 | — |
| WY | — | $8.63 | — |
How the A6242 fee compares
| Measure | Value |
|---|---|
| Rank among 41 A62 codes (lowest = 1) | 18 |
| Family fee range (average of state fees) | $0.05–$56.30 |
| Rural fee uplift | — |
Who bills A6242 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 65 |
| Referring clinicians | 1,016 |
| Medicare beneficiaries | 1,596 |
| States with claims | 37 |
| Share of services in top 3 states (Texas, New York, Illinois) | 30% |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 116 | 5,138 |
| 2023 | 80 | 3,632 |
| 2024 | 65 | 1,596 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for A6242, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 206,402 | 5,138 | $7.41 | $5.76 |
| 2023 | 127,117 | 3,632 | $8.05 | $6.20 |
| 2024 | 51,451 | 1,596 | $8.26 | $6.34 |
States with the most A6242 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Texas | 6,991 | $6.29 |
| New York | 5,195 | $6.40 |
| Illinois | 3,063 | $6.37 |
| California | 2,860 | $6.35 |
| Florida | 2,443 | $6.30 |
Medicare policy articles for this code
- A54563: Surgical Dressings - Policy Article (CGS Administrators, LLC (DME MAC) Noridian Healthcare Solutions, LLC (DME MAC)) — mentions this code in its coding guidance
What changed for A6242
- 2026-01-01: Average state fee rose 2.0%: $8.51 to $8.68
- 1997-01-01: A6242 added to HCPCS Level II
- Next scheduled CMS quarterly update (HCPCS and DMEPOS fee schedule): 2027-01-01
Frequently asked questions
What is HCPCS code A6242?
A6242 is the HCPCS Level II code for hydrogel dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing. Short descriptor: "Hydrogel drg <=16 in w/o bdr".
How much does Medicare pay for A6242?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $8.63–$10.39. Rural fees can be higher.
Does Medicare cover A6242?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
Did the Medicare fee for A6242 change in 2026?
The average non-rural state fee moved from $8.51 in 2025 to $8.68 in 2026 (+2.0%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
Related A62 codes
- A6203 — Composite dressing, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing ($4.80–$5.70)
- 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 ($8.86–$10.62)
- A6205 — Composite dressing, sterile, pad size more than 48 sq. in., with any size adhesive border, each dressing
- A6206 — Contact layer, sterile, 16 sq. in. or less, each dressing
- A6207 — Contact layer, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing ($10.47–$12.56)
- A6208 — Contact layer, sterile, more than 48 sq. in., each dressing
- A6209 — Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing ($10.65–$12.82)
- 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 ($28.40–$34.06)
- A6211 — Foam dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing ($41.86–$50.18)
- A6212 — Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing ($13.84–$16.61)
- 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
- A6214 — Foam dressing, wound cover, sterile, pad size more than 48 sq. in., with any size adhesive border, each dressing ($14.68–$17.62)
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Next steps
- Run a reimbursement report for a device billed under A6242
- Watch A6242 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for A6242
Sources: CMS HCPCS Level II release October 2026; CMS DMEPOS fee schedule 2026; CMS NCCI MUE tables; CMS Medicare utilization (physician and DME supplier files); CMS Medicare Coverage Database articles. Fees are Medicare allowables, not commercial rates. Not billing or legal advice.