2.2.23.6

Wound Care Procedures and Limitations

 

Procedure Code	Maximum Limitation
A4213	As needed
A4216	As needed
A4217	As needed
A4244	As needed
A4246	As needed
A4247	As needed
A4322	As needed
A4450	20 per month
A4452	20 per month
A4455	4 per month without prior authorization
A4461	As needed
A4465	As needed
A4927	As needed
A6010	As needed
A6011	As needed
A6021	As needed
A6022	As needed
A6023	As needed
A6024	As needed
A6025	As needed
A6154	As needed
A6196	As needed
A6197	As needed
A6198	As needed
A6199	As needed
A6203	As needed
A6204	As needed
A6205	As needed
A6206	As needed
A6207	As needed
A6208	As needed
A6209	As needed
A6210	As needed
A6211	As needed
A6212	As needed
A6213	As needed
A6214	As needed
A6215	As needed
A6216	As needed
A6217	As needed
A6218	As needed
A6219	As needed
A6220	As needed
A6221	As needed
A6222	As needed
A6223	As needed
A6224	As needed
A6228	As needed
A6229	As needed
A6230	As needed
A6231	As needed
A6232	As needed
A6233	As needed
A6234	As needed
A6235	As needed
A6236	As needed
A6237	As needed
A6238	As needed
A6239	As needed
A6240	As needed
A6241	As needed
A6242	As needed
A6243	As needed
A6244	As needed
A6245	As needed
A6246	As needed
A6247	As needed
A6248	As needed
A6250	2 per month
A6251	As needed
A6252	As needed
A6253	As needed
A6254	As needed
A6255	As needed
A6256	As needed
A6257	15 per month
A6258	15 per month
A6259	15 per month
A6260	As needed
A6261	As needed
A6262	As needed
A6266	As needed
A6402	As needed
A6403	As needed
A6404	As needed
A6407	As needed
A6410	As needed
A6411	As needed
A6412	As needed
A6441	As needed
A6442	As needed
A6443	As needed
A6444	As needed
A6445	As needed
A6446	As needed
A6447	As needed
A6448	As needed
A6449	As needed
A6450	As needed
A6451	As needed
A6452	As needed
A6453	As needed
A6454	As needed
A6455	As needed
A6456	As needed
A6457	As needed
A6545	As needed, requires modifier AW
A6550	15 per month
A7000	10 per month
E1399	As needed (for use with Pulsatile Jet Irrigation Wound Care System)
E2402	1 per month
T1999	As needed