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See a sample rate comparisonHCPCS A6242 Fee Schedule
Last Verified: September 2026
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.
Hydrogel dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing
| Key Fact | Detail |
|---|---|
| Service Type | Medical And Surgical Supplies Hydrogel Dressings |
| Complexity Level | Low |
| Medicaid Fee Schedule | View Medicaid rates for A6242 |
National average reimbursement for HCPCS A6242 by major payers:
$7.04
$4.52
$5.61
$9.88
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HCPCS A6242
5 of 25 sample ratesHigher to lower in this preview
Chu Chen
Merrimack Valley Pediatric Associates, Inc.
$15.49Published rateAtl Colorectal Surgery
$9.56Published rateFloyd Healthcare Management Inc, Atrium Health Floyd Medical Center
Floyd Healthcare Management, Inc.
$4.21Published rateEmanuel County Hospital Authority, Emanuel Medical Center
$3.98Published rateChristopher Raio
St Joseph Hospital
$2.53Published rate
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See a sample payer proposalHCPCS A6242 vs. Other Hydrogel Dressings Codes
The HCPCS A6242 code is part of the Medical And Surgical Supplies services used for Hydrogel 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 A6242 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 |
|---|---|---|
| A6241-HCPCS | Low | Hydrocolloid dressing, wound filler, dry form, sterile, per gram |
| A6242-HCPCS | Low | Hydrogel dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
| A6243-HCPCS | Low | Hydrogel 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 |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS A6242. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the A6242 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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