2010 HCPCS Schedule - DE Medical Assistance Program

A6246 HYDROGEL DRG >16 48 SQ IN W/B 3 $22.68
A6248 HYDROGEL DRSG GEL FILLER 3 $15.49
A6250 SKIN SEAL PROTECT MOISTURIZR 9 $0.00
A6251 ABSORPT DRG 16 48 SQ IN W/O B 3 $6.05
A6254 ABSORPT DRG 16 48 SQ IN W/BDR 3 $2.89
A6257 TRANSPARENT FILM 16 48 SQ IN 3 $10.43
A6260 WOUND CLEANSER ANY TYPE/SIZE 9 $0.00
A6261 WOUND FILLER GEL/PASTE /OZ 5 $0.00
A6262 WOUND FILLER DRY FORM / GRAM 5 $0.00
A6263 NON-STERILE ELASTIC GAUZE/YD O $0.00
A6264 NON-STERILE NO ELASTIC GAUZE O $0.00
A6265 TAPE PER 18 SQ INCHES O $0.00
A6266 IMPREG GAUZE NO H20/SAL/YARD 3 $1.83
A6402 STERILE GAUZE 16 48 SQ IN 3 $0.41
A6405 STERILE ELASTIC GAUZE /YD O $0.00
A6406 STERILE NON-ELASTIC GAUZE/YD O $0.00
A6407 PACKING STRIPS, NON-IMPREG 3 $1.88
A6410 STERILE EYE PAD 5 $0.00
A6411 NON-STERILE EYE PAD 5 $0.00
A6412 OCCLUSIVE EYE PATCH 5 $0.00
A6413 ADHESIVE BANDAGE, FIRST-AID 9 $0.00
A6421 PAD BANDAGE >=3 =3=5ÊW /ROLL O $0.00
A6426 CONF BANDAGE S >=3=5Ê W /ROLL O $0.00
A6430 LT COMPRES BDG >=3=5ÊW /ROLL O $0.00
A6434 MO COMPRES BDG >=3=3=3=3=3" =3"