August 28, 2025
Widespread Pre-Pay Service Specific Medical Record Review Announcement – HCPCS Code A6023
CGS will conduct a medical record pre-pay review of claims that have the code A6023:
- A6023 – COLLAGEN DRESSING, SIZE GRATER THAN 48 SQUARE INCHES
The Surgical Dressing policy group ranks high in Comprehensive Error Rate Testing (CERT) errors for Jurisdiction B and Jurisdiction C. Data analysis also showed multiple suppliers using the A6023 HCPCS more than expected.
CGS will review medical records for selected claims before payment. This review does not target any specific supplier or provider.
CGS will send Additional Documentation Requests (ADR) for these claims. It is important to respond to ADR letters. Federal Law at SSA 1815(a), 1833(e), and 1862(a)(1) (A) authorizes the collection of this information. Suppliers are in violation of Supplier Standard #28 when, upon request, they fail to provide requested documentation to a Medicare contractor like CGS.
Failure to provide records may result in a claim denial and referral to the National Provider Enrollment (NPE) contractor and/or UPIC.
The ADR letter will have the following information:
- Treating practitioner's written order
- Documentation defining the number of wounds being treated with a dressing/would filler
- Documentation of evaluation of the wound(s) during the month prior to the date of service on the claim that includes the type of each wound (e.g., surgical wound, pressure ulcer, burn, etc.), location, size (length x width in cm.), depth, amount of drainage, whether the dressing is a primary or secondary dressing and/or any other relevant information. Medical records must document that the Local Coverage Determination criteria have been met for the specific dressing type. These records must be obtained from the treating practitioner, nursing home, or home care nurse. The source of that information must be documented.
- Any other pertinent documentation
- Copy of Advance Beneficiary Notice (ABN), if one was obtained
Resources
- Surgical Dressings LCD

- Surgical Dressings Policy Article

- Standard Documentation Requirements for All Claims Submitted to DME MACs Policy Article

- Surgical Dressings Documentation Checklist

- Additional Documentation Request (ADR) Process
- Medicare Minute® MD Medicare and Surgical Dressings
- Physicians! Are You Ordering Surgical Dressings for Your Patients?
- Surgical Dressings Q&A

