| Jurisdiction A DME MAC | ||||||||||||||
| 2007 DMEPOS/PEN Fee Schedule Updates (Revised 4/2/07) | ||||||||||||||
| Inclusion of a fee schedule amount for an item does not necessarily indicate coverage | ||||||||||||||
| Surgical Dressings | ||||||||||||||
| HCPCS | Mod1 | Mod2 | CT | DC | DE | MA | MD | ME | NH | NJ | NY | PA | RI | VT |
| A4461 | $3.29 | $3.29 | $3.29 | $3.29 | $3.29 | $3.29 | $3.29 | $3.29 | $3.29 | $3.29 | $3.29 | $3.29 | ||
| A4463 | $13.31 | $13.31 | $13.31 | $13.31 | $13.31 | $13.31 | $13.31 | $13.31 | $13.31 | $13.31 | $13.31 | $13.31 | ||
| A6010 | $30.96 | $30.96 | $30.96 | $30.96 | $30.96 | $30.96 | $30.96 | $30.96 | $30.96 | $30.96 | $30.96 | $30.96 | ||
| A6011 | $2.28 | $2.28 | $2.28 | $2.28 | $2.28 | $2.28 | $2.28 | $2.28 | $2.28 | $2.28 | $2.28 | $2.28 | ||
| A6021 | $21.02 | $21.02 | $21.02 | $21.02 | $21.02 | $21.02 | $21.02 | $21.02 | $21.02 | $21.02 | $21.02 | $21.02 | ||
| A6022 | $21.02 | $21.02 | $21.02 | $21.02 | $21.02 | $21.02 | $21.02 | $21.02 | $21.02 | $21.02 | $21.02 | $21.02 | ||
| A6023 | $190.30 | $190.30 | $190.30 | $190.30 | $190.30 | $190.30 | $190.30 | $190.30 | $190.30 | $190.30 | $190.30 | $190.30 | ||
| A6024 | $6.19 | $6.19 | $6.19 | $6.19 | $6.19 | $6.19 | $6.19 | $6.19 | $6.19 | $6.19 | $6.19 | $6.19 | ||
| A6154 | $14.38 | $13.93 | $14.38 | $14.38 | $13.93 | $14.38 | $14.38 | $14.38 | $14.38 | $14.38 | $14.38 | $14.38 | ||
| A6196 | $7.35 | $7.35 | $7.35 | $7.35 | $7.35 | $7.35 | $7.35 | $7.35 | $7.35 | $7.35 | $7.35 | $7.35 | ||
| A6197 | $16.44 | $16.44 | $16.44 | $16.44 | $16.44 | $16.44 | $16.44 | $16.44 | $16.44 | $16.44 | $16.44 | $16.44 | ||
| A6199 | $5.29 | $5.29 | $5.29 | $5.29 | $5.29 | $5.29 | $5.29 | $5.29 | $5.29 | $5.29 | $5.29 | $5.29 | ||
| A6200 | $9.50 | $9.50 | $9.50 | $9.50 | $9.50 | $9.50 | $9.50 | $9.50 | $9.50 | $9.50 | $9.50 | $9.50 | ||
| A6201 | $20.80 | $20.80 | $20.80 | $20.80 | $20.80 | $20.80 | $20.80 | $20.80 | $20.80 | $20.80 | $20.80 | $20.80 | ||
| A6202 | $34.88 | $34.88 | $34.88 | $34.88 | $34.88 | $34.88 | $34.88 | $34.88 | $34.88 | $34.88 | $34.88 | $34.88 | ||
| A6203 | $3.35 | $3.35 | $3.35 | $3.35 | $3.35 | $3.35 | $3.35 | $3.35 | $3.35 | $3.35 | $3.35 | $3.35 | ||
| A6204 | $6.23 | $6.23 | $6.23 | $6.23 | $6.23 | $6.23 | $6.23 | $6.23 | $6.23 | $6.23 | $6.23 | $6.23 | ||
| A6207 | $7.34 | $7.34 | $7.34 | $7.34 | $7.34 | $7.34 | $7.34 | $7.34 | $7.34 | $7.34 | $7.34 | $7.34 | ||
| A6209 | $7.48 | $7.48 | $7.48 | $7.48 | $7.48 | $7.48 | $7.48 | $7.48 | $7.48 | $7.48 | $7.48 | $7.48 | ||
| A6210 | $19.92 | $19.92 | $19.92 | $19.92 | $19.92 | $19.92 | $19.92 | $19.92 | $19.92 | $19.92 | $19.92 | $19.92 | ||
| A6211 | $29.37 | $29.37 | $29.37 | $29.37 | $29.37 | $29.37 | $29.37 | $29.37 | $29.37 | $29.37 | $29.37 | $29.37 | ||
| A6212 | $9.70 | $9.70 | $9.70 | $9.70 | $9.70 | $9.70 | $9.70 | $9.70 | $9.70 | $9.70 | $9.70 | $9.70 | ||
| A6214 | $10.29 | $10.29 | $10.29 | $10.29 | $10.29 | $10.29 | $10.29 | $10.29 | $10.29 | $10.29 | $10.29 | $10.29 | ||
| A6216 | $0.05 | $0.05 | $0.05 | $0.05 | $0.05 | $0.05 | $0.05 | $0.05 | $0.05 | $0.05 | $0.05 | $0.05 | ||
| A6219 | $0.95 | $0.95 | $0.95 | $0.95 | $0.95 | $0.95 | $0.95 | $0.95 | $0.95 | $0.95 | $0.95 | $0.95 | ||
| A6220 | $2.58 | $2.58 | $2.58 | $2.58 | $2.58 | $2.58 | $2.58 | $2.58 | $2.58 | $2.58 | $2.58 | $2.58 | ||
| A6222 | $2.13 | $2.13 | $2.13 | $2.13 | $2.13 | $2.13 | $2.13 | $2.13 | $2.13 | $2.13 | $2.13 | $2.13 | ||
| A6223 | $2.42 | $2.42 | $2.42 | $2.42 | $2.42 | $2.42 | $2.42 | $2.42 | $2.42 | $2.42 | $2.42 | $2.42 | ||
| A6224 | $3.61 | $3.61 | $3.61 | $3.61 | $3.61 | $3.61 | $3.61 | $3.61 | $3.61 | $3.61 | $3.61 | $3.61 | ||
| A6229 | $3.61 | $3.61 | $3.61 | $3.61 | $3.61 | $3.61 | $3.61 | $3.61 | $3.61 | $3.61 | $3.61 | $3.61 | ||
| A6231 | $4.66 | $4.66 | $4.66 | $4.66 | $4.66 | $4.66 | $4.66 | $4.66 | $4.66 | $4.66 | $4.66 | $4.66 | ||
| A6232 | $6.88 | $6.88 | $6.88 | $6.88 | $6.88 | $6.88 | $6.88 | $6.88 | $6.88 | $6.88 | $6.88 | $6.88 | ||
| A6233 | $19.19 | $19.19 | $19.19 | $19.19 | $19.19 | $19.19 | $19.19 | $19.19 | $19.19 | $19.19 | $19.19 | $19.19 | ||
| A6234 | $6.54 | $6.54 | $6.54 | $6.54 | $6.54 | $6.54 | $6.54 | $6.54 | $6.54 | $6.54 | $6.54 | $6.54 | ||
| A6235 | $16.82 | $16.82 | $16.82 | $16.82 | $16.82 | $16.82 | $16.82 | $16.82 | $16.82 | $16.82 | $16.82 | $16.82 | ||
| A6236 | $27.25 | $27.25 | $27.25 | $27.25 | $27.25 | $27.25 | $27.25 | $27.25 | $27.25 | $27.25 | $27.25 | $27.25 | ||
| A6237 | $7.91 | $7.91 | $7.91 | $7.91 | $7.91 | $7.91 | $7.91 | $7.91 | $7.91 | $7.91 | $7.91 | $7.91 | ||
| A6238 | $22.79 | $22.79 | $22.79 | $22.79 | $22.79 | $22.79 | $22.79 | $22.79 | $22.79 | $22.79 | $22.79 | $22.79 | ||
| A6240 | $12.24 | $12.24 | $12.24 | $12.24 | $12.24 | $12.24 | $12.24 | $12.24 | $12.24 | $12.24 | $12.24 | $12.24 | ||
| A6241 | $2.57 | $2.57 | $2.57 | $2.57 | $2.57 | $2.57 | $2.57 | $2.57 | $2.57 | $2.57 | $2.57 | $2.57 | ||
| A6242 | $6.07 | $6.07 | $6.07 | $6.07 | $6.07 | $6.07 | $6.07 | $6.07 | $6.07 | $6.07 | $6.07 | $6.07 | ||
| A6243 | $12.31 | $12.31 | $12.31 | $12.31 | $12.31 | $12.31 | $12.31 | $12.31 | $12.31 | $12.31 | $12.31 | $12.31 | ||
| A6244 | $39.28 | $39.28 | $39.28 | $39.28 | $39.28 | $39.28 | $39.28 | $39.28 | $39.28 | $39.28 | $39.28 | $39.28 | ||
| A6245 | $7.27 | $7.27 | $7.27 | $7.27 | $7.27 | $7.27 | $7.27 | $7.27 | $7.27 | $7.27 | $7.27 | $7.27 | ||
| A6246 | $9.92 | $9.92 | $9.92 | $9.92 | $9.92 | $9.92 | $9.92 | $9.92 | $9.92 | $9.92 | $9.92 | $9.92 | ||
| A6247 | $23.78 | $23.78 | $23.78 | $23.78 | $23.78 | $23.78 | $23.78 | $23.78 | $23.78 | $23.78 | $23.78 | $23.78 | ||
| A6248 | $16.24 | $16.24 | $16.24 | $16.24 | $16.24 | $16.24 | $16.24 | $16.24 | $16.24 | $16.24 | $16.24 | $16.24 | ||
| A6251 | $1.99 | $1.99 | $1.99 | $1.99 | $1.99 | $1.99 | $1.99 | $1.99 | $1.99 | $1.99 | $1.99 | $1.99 | ||
| A6252 | $3.25 | $3.25 | $3.25 | $3.25 | $3.25 | $3.25 | $3.25 | $3.25 | $3.25 | $3.25 | $3.25 | $3.25 | ||
| A6253 | $6.34 | $6.34 | $6.34 | $6.34 | $6.34 | $6.34 | $6.34 | $6.34 | $6.34 | $6.34 | $6.34 | $6.34 | ||
| A6254 | $1.21 | $1.21 | $1.21 | $1.21 | $1.21 | $1.21 | $1.21 | $1.21 | $1.21 | $1.21 | $1.21 | $1.21 | ||
| A6255 | $3.03 | $3.03 | $3.03 | $3.03 | $3.03 | $3.03 | $3.03 | $3.03 | $3.03 | $3.03 | $3.03 | $3.03 | ||
| A6257 | $1.53 | $1.53 | $1.53 | $1.53 | $1.53 | $1.53 | $1.53 | $1.53 | $1.53 | $1.53 | $1.53 | $1.53 | ||
| A6258 | $4.30 | $4.30 | $4.30 | $4.30 | $4.30 | $4.30 | $4.30 | $4.30 | $4.30 | $4.30 | $4.30 | $4.30 | ||
| A6259 | $10.94 | $10.94 | $10.94 | $10.94 | $10.94 | $10.94 | $10.94 | $10.94 | $10.94 | $10.94 | $10.94 | $10.94 | ||
| A6266 | $1.92 | $1.92 | $1.92 | $1.92 | $1.92 | $1.92 | $1.92 | $1.92 | $1.92 | $1.92 | $1.92 | $1.92 | ||
| A6402 | $0.12 | $0.12 | $0.12 | $0.12 | $0.12 | $0.12 | $0.12 | $0.12 | $0.12 | $0.12 | $0.12 | $0.12 | ||
| A6403 | $0.43 | $0.43 | $0.43 | $0.43 | $0.43 | $0.43 | $0.43 | $0.43 | $0.43 | $0.43 | $0.43 | $0.43 | ||
| A6407 | $1.88 | $1.88 | $1.88 | $1.88 | $1.88 | $1.88 | $1.88 | $1.88 | $1.88 | $1.88 | $1.88 | $1.88 | ||
| A6410 | $0.39 | $0.39 | $0.39 | $0.39 | $0.39 | $0.39 | $0.39 | $0.39 | $0.39 | $0.39 | $0.39 | $0.39 | ||
| A6441 | $0.67 | $0.67 | $0.67 | $0.67 | $0.67 | $0.67 | $0.67 | $0.67 | $0.67 | $0.67 | $0.67 | $0.67 | ||
| A6442 | $0.17 | $0.17 | $0.17 | $0.17 | $0.17 | $0.17 | $0.17 | $0.17 | $0.17 | $0.17 | $0.17 | $0.17 | ||
| A6443 | $0.29 | $0.29 | $0.29 | $0.29 | $0.29 | $0.29 | $0.29 | $0.29 | $0.29 | $0.29 | $0.29 | $0.29 | ||
| A6444 | $0.56 | $0.56 | $0.56 | $0.56 | $0.56 | $0.56 | $0.56 | $0.56 | $0.56 | $0.56 | $0.56 | $0.56 | ||
| A6445 | $0.32 | $0.32 | $0.32 | $0.32 | $0.32 | $0.32 | $0.32 | $0.32 | $0.32 | $0.32 | $0.32 | $0.32 | ||
| A6446 | $0.41 | $0.41 | $0.41 | $0.41 | $0.41 | $0.41 | $0.41 | $0.41 | $0.41 | $0.41 | $0.41 | $0.41 | ||
| A6447 | $0.67 | $0.67 | $0.67 | $0.67 | $0.67 | $0.67 | $0.67 | $0.67 | $0.67 | $0.67 | $0.67 | $0.67 | ||
| A6448 | $1.16 | $1.16 | $1.16 | $1.16 | $1.16 | $1.16 | $1.16 | $1.16 | $1.16 | $1.16 | $1.16 | $1.16 | ||
| A6449 | $1.75 | $1.75 | $1.75 | $1.75 | $1.75 | $1.75 | $1.75 | $1.75 | $1.75 | $1.75 | $1.75 | $1.75 | ||
| A6452 | $5.91 | $5.91 | $5.91 | $5.91 | $5.91 | $5.91 | $5.91 | $5.91 | $5.91 | $5.91 | $5.91 | $5.91 | ||
| A6453 | $0.61 | $0.61 | $0.61 | $0.61 | $0.61 | $0.61 | $0.61 | $0.61 | $0.61 | $0.61 | $0.61 | $0.61 | ||
| A6454 | $0.77 | $0.77 | $0.77 | $0.77 | $0.77 | $0.77 | $0.77 | $0.77 | $0.77 | $0.77 | $0.77 | $0.77 | ||
| A6455 | $1.39 | $1.39 | $1.39 | $1.39 | $1.39 | $1.39 | $1.39 | $1.39 | $1.39 | $1.39 | $1.39 | $1.39 | ||
| A6456 | $1.28 | $1.28 | $1.28 | $1.28 | $1.28 | $1.28 | $1.28 | $1.28 | $1.28 | $1.28 | $1.28 | $1.28 | ||
| A6457 | $1.14 | $1.14 | $1.14 | $1.14 | $1.14 | $1.14 | $1.14 | $1.14 | $1.14 | $1.14 | $1.14 | $1.14 | ||
| A6531 | AW | $43.27 | $43.27 | $43.27 | $43.27 | $43.27 | $43.27 | $43.27 | $43.27 | $43.27 | $43.27 | $43.27 | $43.27 | |
| A6532 | AW | $60.96 | $60.96 | $60.96 | $60.96 | $60.96 | $60.96 | $60.96 | $60.96 | $60.96 | $60.96 | $60.96 | $60.96 | |