A6455 — Self-adherent bandage, elastic, non-knitted/non-woven, width greater than or equal to five inches, per yard
A6455 is a HCPCS Level II code for self-adherent bandage, elastic, non-knitted/non-woven, width greater than or equal to five inches, per yard. It belongs to the Transportation, Medical & Surgical Supplies, Administrative section. Whether Medicare pays it depends on the coverage rule below.
Medicare coverage: Carrier judgment
Coverage is decided by your Medicare contractor, not by national policy. Whether this is paid depends on the LCD for your jurisdiction and on what the documentation supports.
From the coverage field of the CMS Alpha-Numeric HCPCS File, release 2026Q3-Jul. This states Medicare’s position on the code, not on your particular claim.
Physician fee schedule statusX
Statutory exclusion. The item or service is not within the statutory definition of 'physician services', so the fee schedule never pays it.
Global period: XXX
Want the dollar amount for your locality? The fee calculator applies your GPCI and the current conversion factor.
Medically Unlikely Edits — units per day
The most units of A6455 Medicare will pay on one date of service. Bill more on a single line and it is denied. The limit is not the same in every setting, so the row that matters is the one matching the claim you are building.
- practitioner
- 0 — never payable MAI 3 — Date of Service Edit: Clinical · CMS Policy
- outpatient
- 4 units MAI 3 — Date of Service Edit: Clinical · Clinical: Data
The adjudication indicator decides whether exceeding the limit is worth appealing at all: MAI 1 is a line edit you can support with documentation, MAI 3 is a date-of-service edit that is also appealable, and MAI 2 is absolute — no documentation overrides it. CMS MUE 2026Q3.
The CMS record for A6455
- Long descriptor
- Self-adherent bandage, elastic, non-knitted/non-woven, width greater than or equal to five inches, per yard
- Short descriptor
- Self-adher band >=5"/yd
- Added
- January 1, 2004
- BETOS
- D1A
- Pricing indicator
- 35 — DMEPOS
The official wording. This is what the code means.
CMS's 28-character form, which is what shows up on a remittance advice.
When CMS introduced the code.
Berenson-Eggers Type of Service — CMS's own analytic grouping.
Surgical dressings. Price subject to floors and ceilings.
Codes adjacent to A6455
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If A6455 is not quite right, the correct code is very often within a few positions of it.
- A6447Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to five inches, per yard
- A6448Light compression bandage, elastic, knitted/woven, width less than three inches, per yard
- A6449Light compression bandage, elastic, knitted/woven, width greater than or equal to three inches and less than five inches, per yard
- A6450Light compression bandage, elastic, knitted/woven, width greater than or equal to five inches, per yard
- A6451Moderate compression bandage, elastic, knitted/woven, load resistance of 1.25 to 1.34 foot pounds at 50% maximum stretch, width greater than or equal to three inches and less than five inches, per yard
- A6452High compression bandage, elastic, knitted/woven, load resistance greater than or equal to 1.35 foot pounds at 50% maximum stretch, width greater than or equal to three inches and less than five inches, per yard
- A6453Self-adherent bandage, elastic, non-knitted/non-woven, width less than three inches, per yard
- A6454Self-adherent bandage, elastic, non-knitted/non-woven, width greater than or equal to three inches and less than five inches, per yard
- A6456Zinc paste impregnated bandage, non-elastic, knitted/woven, width greater than or equal to three inches and less than five inches, per yard
- A6457Tubular dressing with or without elastic, any width, per linear yard
- A6460Synthetic resorbable wound dressing, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing
- A6461Synthetic resorbable wound dressing, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing
- A6501Compression burn garment, bodysuit (head to foot), custom fabricated
- A6502Compression burn garment, chin strap, custom fabricated
- A6503Compression burn garment, facial hood, custom fabricated
- A6504Compression burn garment, glove to wrist, custom fabricated
Questions about A6455
What is HCPCS code A6455?
A6455 is a HCPCS Level II code for self-adherent bandage, elastic, non-knitted/non-woven, width greater than or equal to five inches, per yard. It sits in the Transportation, Medical & Surgical Supplies, Administrative section.
Does Medicare cover A6455?
The CMS HCPCS file marks A6455 as "Carrier judgment". Coverage is decided by your Medicare contractor, not by national policy. Whether this is paid depends on the LCD for your jurisdiction and on what the documentation supports.
How is A6455 paid under the physician fee schedule?
A6455 carries PFS status code X. Statutory exclusion. The item or service is not within the statutory definition of 'physician services', so the fee schedule never pays it.