Article Detail - JA DME

The Policy Article (A54563) was recently updated with example scenarios to assist the supplier community in determining when to use the A1-A9 modifiers.

Modifiers A1-A9 have been established to indicate that a particular HCPCS code is being used as a primary or secondary dressing on a qualifying surgical or debrided wound. Modifiers A1-A9 are used to indicate the number of qualifying wounds on which a specific dressing HCPCS code is being used.

The modifier number must correspond to the number of qualifying wounds on which the dressing HCPCS code is being used, not the total number of wounds treated.

Modifiers A1-A9 are not used with codes A6531 and A6532.

Example Scenarios:

• September 1 Dressing Shipment: Beneficiary has two wounds that require two different categories of dressings, A61XX (max allowance of 30 per month) and A62XX (max allowance of 12 per month)
  • Supplier should bill:
    • A61XX A1 UOS = 30
    • A62XX A1 UOS = 12
• September 15 Dressing Shipment: Beneficiary has a new wound that requires one of the same categories of dressings as another wound (A61XX – max allowance of 30 per month)
  • Supplier should supply and bill 15 units (to last for the next 2 weeks) and should append the A2 modifier because this dressing category is now used on 2 wounds. NOTE: The modifier number corresponds to the number of wounds on which the dressing is being used, not the total number of wounds treated.
    • A61XX A2 UOS = 15
• October 1 Dressing Shipment: Beneficiary still has three wounds: two require A61XX (max allowance of 60 per month) and one requires A62XX (max allowance of 12 per month)
  • Supplier should bill:
    • A61XX A2 UOS = 60
    • A62XX A1 UOS = 12

The Noridian Surgical Dressings webpage has additional information about surgical supplies, including Local Coverage Determination (LCD) L33803 and Policy Article (A54563).