HCPCS A6216 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | • Medical And Surgical Supplies • Gauze Dressings |
| Complexity Level | Low |
National average reimbursement for HCPCS A6216 by major payers:
$0.07
$0.04
$0.04
$0.38
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for HCPCS A6216 | ||||||
United | A6216 | $0.02 | 1184120834 - ASHA TIPIRNENI | 160743209 - UNIVERSITY OF ROCHESTER | NY | Hematology & Oncology Physician (207RH0003X) |
United | A6216 | $0.02 | 1104086925 - AIMEE CRAGO | 20594889 - (NY) MSKCC REGIONAL NETWORK | NY | Surgical Oncology Physician (2086X0206X) |
United | A6216 | $0.01 | 1902801921 - VISAHARAN SIVASUBRAMANIAM | 112419534 - (NY) NORTH SHORE HEMATOLOGY-ONCOLOGY ASSOCIATES, P.C. | NY | Hematology & Oncology Physician (207RH0003X) |
United | A6216 | $0.02 | 1316194293 - CATHERINE MCGUINN | 131623978 | NY | Pediatric Hematology & Oncology Physician (2080P0207X) |
United | A6216 | $0.02 | 1770800732 - ROBERT DALY | 300937486 | NY | Medical Oncology Physician (207RX0202X) |
United | A6216 | $0.03 | 1104995356 - ELI SERUR | 200096809 - PHYSICIANS OF UNIVERSITY HOSPITAL PC | NY | Gynecologic Oncology Physician (207VX0201X) |
United | A6216 | $0.02 | 1124227889 - INDER LAL | 222594672 - CONCORD HOSPITAL INC | NY | Hematology & Oncology Physician (207RH0003X) |
United | A6216 | $0.10 | 1851737308 - ALEXANDRA GOMEZ ARTEAGA | 131623978 | NY | Hematology & Oncology Physician (207RH0003X) |
United | A6216 | $0.02 | 1588197453 - JARED ROWLEY | 300168273 - (NY) MAIMONIDES DIVISION OF RADIATION ONCOLOGY FPP | NY | Radiation Oncology Physician (2085R0001X) |
United | A6216 | $0.02 | 1932138468 - PETER DOTTINO | 60646973 - YALE UNIVERSITY | NY | Gynecologic Oncology Physician (207VX0201X) |
United | A6216 | $0.02 | 1720379233 - MICHAEL MIX | 161576637 - FAXTON-ST LUKES HEALTHCARE | NY | Radiation Oncology Physician (2085R0001X) |
United | A6216 | $0.02 | 1245202662 - KENNETH RIVLIN | 900603487 - PHYSICIAN AFFILIATE GROUP OF NEW YORK PC | NY | Pediatric Hematology & Oncology Physician (2080P0207X) |
United | A6216 | $0.05 | 1447756010 - LANYI CHEN | 135598093 - COLUMBIA UNIVERSITY IN THE CITY OF NEW YORK | NY | Medical Oncology Physician (207RX0202X) |
United | A6216 | $0.07 | 1538197975 - AJEET GAJRA | 161184100 - (NY) HEMATOLOGY-ONCOLOGY ASSOCIATES OF CENTRAL NEW YORK, P.C. | NY | Hematology & Oncology Physician (207RH0003X) |
United | A6216 | $0.03 | 1710982731 - HERBERT DUVIVIER | 203639329 | NY | Hematology & Oncology Physician (207RH0003X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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HCPCS A6216 vs. Other Gauze Dressings Codes
The HCPCS A6216 code is part of the Medical And Surgical Supplies services used for Gauze Dressings. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The HCPCS A6216 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| A6215-HCPCS | Low | Foam dressing, wound filler, sterile, per gram |
| A6216-HCPCS | Low | Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
| A6217-HCPCS | Low | Gauze, non-impregnated, non-sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS A6216. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the A6216 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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