Product line · HCPCS A6010–A6204 · the Vitalé line

Surgical dressings

Collagen powders and dressings, composite island dressings, and silicone composite dressings — in the post-operative sizes care teams ask for. We carry the Vitalé line and can source other categories on request.

HCPCS A6010–A6204 LCD L33831 No prior authorization No WOPD

See the line How to order

What it is

Wound care for the post-surgical pathway

Surgical dressings cover and support healing of surgical and certain other wounds. Different chemistries do different jobs: collagen dressings (and powder) support the wound bed; composite island dressings combine an absorbent pad with an adhesive border; silicone composite dressings add a gentler, atraumatic contact layer. The right product and size depend on the wound and the care plan.

These items are billed under Local Coverage Determination L33831 (Surgical Dressings). There is no prior-authorization requirement and no Written Order Prior to Delivery requirement — coverage turns on the order and the medical-record documentation supporting medical necessity, with the usual quantity and frequency expectations under L33831.

The Vitalé line

Products, codes & sizes

What we stock in the Vitalé surgical-dressing line:

The Vitalé surgical-dressing line. All items billed under LCD L33831 (Surgical Dressings). No prior authorization and no WOPD required for these codes.
HCPCS	Product	Size(s)
`A6010`	Collagen Powder	1 g packets
`A6021`	Collagen Dressing	2 in × 2 in
`A6023`	Collagen Dressing	7 in × 7 in
`A6203`	Composite Island Dressing	4 in × 6 in; 4 in × 10 in
`A6203`	Silicone Composite Dressing	3.5 in × 4 in
`A6204`	Composite Island Dressing	4 in × 14 in
`A6204`	Silicone Composite Dressing	9 in × 9 in

Need a different dressing? Alginate, foam, hydrogel, and other categories can be sourced on request — tell us the wound type, size, and any product preference when you send the order and we'll get it.

Ordering

How to order surgical dressings

Order form

Surgical Dressing Standard Written Order

Fillable PDF · 63 KB · covers the Vitalé line: A6010, A6021, A6023, A6203, A6204 · captures wound location, type, dimensions, drainage and length-of-need per LCD L33831 · "Other" row for alginate, foam, hydrogel, and any non-Vitalé item we source on request.

Download SWO (PDF)

Specify the product, code & size

Identify the dressing type, the HCPCS code, the size, and the quantity/frequency the care plan calls for. The medical record should support medical necessity per LCD L33831.

Send the order

Fax to 509-980-7062, email rx@petersonmedicalequipment.com via a secure channel, or call 509-783-7501.

We fulfill & archive

We dispense the dressings, arrange resupply where appropriate, and archive the order and documentation.

Documentation questions? Ask the coverage assistant — it cites the governing LCD. General reference only — not a coverage guarantee, and not for patient details.

Send a surgical-dressing order

Fax to 509-980-7062 or call us — and tell us if you need a category we don't list.