A6404 HCPCS code: Gauze, non-impregnated, sterile, pad size more than 48 sq. in., without adhesive border, each dressing
A6404 is the HCPCS Level II code for gauze, non-impregnated, sterile, pad size more than 48 sq. in., without adhesive border, each dressing. In 2024 Medicare paid an average of $0.96 per service for A6404 across 622 services. Its Medicare coverage code is D (Special coverage instructions apply): Medicare covers it when its national or local coverage criteria are met. The NCCI unit limit is 2 per day on outpatient hospital claims. Medicare volume fell 28% from 2022 to 2024 (869 to 622 services). In 2024, 5 suppliers billed Medicare for A6404 (purchases), serving 13 beneficiaries.
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 | 2003-01-01 |
Who bills A6404 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 5 |
| Referring clinicians | 11 |
| Medicare beneficiaries | 13 |
| States with claims | 0 |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 6 | 19 |
| 2023 | 7 | 24 |
| 2024 | 5 | 13 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for A6404, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 869 | 19 | $2.05 | $1.62 |
| 2023 | 1,415 | 24 | $1.40 | $1.09 |
| 2024 | 622 | 13 | $1.22 | $0.96 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 2 | Clinical: Data |
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 A6404
- 1997-01-01: A6404 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 A6404?
A6404 is the HCPCS Level II code for gauze, non-impregnated, sterile, pad size more than 48 sq. in., without adhesive border, each dressing. Short descriptor: "Sterile gauze > 48 sq in".
How much does Medicare pay for A6404?
In 2024, the average Medicare payment was $0.96 per service (average allowed $1.22).
Does Medicare cover A6404?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
How many units of A6404 can be billed per day?
2 on outpatient hospital claims (NCCI medically unlikely edits).
Related A64 codes
- A6402 — Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing ($0.15–$0.18)
- 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 ($0.58–$0.73)
- A6407 — Packing strips, non-impregnated, sterile, up to 2 inches in width, per linear yard ($2.66–$3.21)
- A6410 — Eye pad, sterile, each ($0.53–$0.68)
- A6411 — Eye pad, non-sterile, each
- A6412 — Eye patch, occlusive, each
- A6413 — Adhesive bandage, first-aid type, any size, each
- A6441 — Padding bandage, non-elastic, non-woven/non-knitted, width greater than or equal to three inches and less than five inches, per yard ($0.97–$1.16)
- A6442 — Conforming bandage, non-elastic, knitted/woven, non-sterile, width less than three inches, per yard ($0.23–$0.35)
- A6443 — Conforming bandage, non-elastic, knitted/woven, non-sterile, width greater than or equal to three inches and less than five inches, per yard ($0.40–$0.48)
- A6444 — Conforming bandage, non-elastic, knitted/woven, non-sterile, width greater than or equal to 5 inches, per yard ($0.80–$0.99)
- A6445 — Conforming bandage, non-elastic, knitted/woven, sterile, width less than three inches, per yard ($0.45–$0.51)
Building a device that would bill under a code like this? Caduvo matches a device description to HCPCS/CPT codes, Medicare coverage and payment, and the FDA pathway in one report.
Next steps
- Run a reimbursement report for a device billed under A6404
- Watch A6404 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for A6404
Sources: CMS HCPCS Level II release October 2025; CMS DMEPOS fee schedule; 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.