MyMedi-AI

A4342 — Accessories for patient inserted indwelling intraurethral drainage device with valve, replacement only, each

HCPCS Level II A-code · short descriptor: “Iduc valve sply repl”

Code system
HCPCS Level II
Family
A — Medical & surgical supplies, ambulance
Medicare coverage status
Carrier judgment — coverage decided by the DME MAC
DMEPOS payment category
Ostomy, tracheostomy & urological supplies
Prior authorization
Not on Medicare required-PA list
Face-to-face & WOPD
Not on the required list
MUE unit limit
4
Status
Active (HCPCS Level II October 2026)

Prior authorization

Not on the Medicare required-PA list (CMS Required Prior Authorization List — 74 items in force on 2026-10-16; 8 more from 2026-10-28; sources: CMS list updated 2026-01-13, CMS-6109-N (91 FR 47972)). Medicare Advantage and commercial plans set their own prior-authorization rules for this code — verify per plan before delivery.

Order readiness — what the written order must contain

Every Medicare DMEPOS claim needs a Standard Written Order with all six elements (42 CFR 410.38(d)):

  • Beneficiary name or Medicare Beneficiary Identifier (MBI) (42 CFR 410.38(d)(1)(i)(A))
  • General description of the item (42 CFR 410.38(d)(1)(i)(B))
  • Quantity to be dispensed, if applicable (42 CFR 410.38(d)(1)(i)(C))
  • Order date (42 CFR 410.38(d)(1)(i)(D))
  • Treating practitioner name or NPI (42 CFR 410.38(d)(1)(i)(E))
  • Treating practitioner signature (42 CFR 410.38(d)(1)(i)(F))

Not on the F2F/WOPD list (CMS Required F2F & WOPD List — 83 items in force on 2026-10-16; 22 more from 2026-10-28; sources: CMS list effective 2026-04-13 (91 FR 1250), CMS-6109-N (91 FR 47972)). The standard written order must reach the supplier before claim submission.

Blank requirements checklist only — MyMedi-AI never collects or stores completed orders.

A4342 Medicare fee schedule (October 2026)

Base (no modifier) Ostomy, tracheostomy & urological supplies

Medicare allowable: $878.06 in all listed states.

Former-CBA payment limits: ceiling $878.06 · floor $746.35

StateNon-ruralRural
AK$878.06—
AL$878.06—
AR$878.06—
AZ$878.06—
CA$878.06—
CO$878.06—
CT$878.06—
DC$878.06—
DE$878.06—
FL$878.06—
GA$878.06—
HI$878.06—
IA$878.06—
ID$878.06—
IL$878.06—
IN$878.06—
KS$878.06—
KY$878.06—
LA$878.06—
MA$878.06—
MD$878.06—
ME$878.06—
MI$878.06—
MN$878.06—
MO$878.06—
MS$878.06—
MT$878.06—
NC$878.06—
ND$878.06—
NE$878.06—
NH$878.06—
NJ$878.06—
NM$878.06—
NV$878.06—
NY$878.06—
OH$878.06—
OK$878.06—
OR$878.06—
PA$878.06—
PR$878.06—
RI$878.06—
SC$878.06—
SD$878.06—
TN$878.06—
TX$878.06—
UT$878.06—
VA$878.06—
VI$878.06—
VT$878.06—
WA$878.06—
WI$878.06—
WV$878.06—
WY$878.06—
Amounts are the Medicare DMEPOS fee-schedule allowables effective October 2026 (CMS DMEPOS Fee Schedule October 2026 (DME26-D)). Medicare typically pays 80% of the allowable after the Part B deductible; the patient owes 20%. A 2% sequestration reduction applies to the Medicare share. Former competitive-bidding-area adjustments and non-continental rates can differ — verify with your DME MAC.

Unit limit (MUE)

Medicare's Medically Unlikely Edit caps A4342 at 4 units per date of service (clinical). Units above the MUE deny — typically as CO-151. Rationale: Nature of Equipment.

Common denial codes to watch

Related A-codes

Bill A4342 with confidence

MyMedi-AI scrubs whole claims against CMS MUE limits, modifier rules, and PA and F2F/WOPD flags before you submit — built for DME teams, PHI-free: no patient data is collected or stored.

Start free trial   Run a CMS-0057-F readiness check

Prefer DIY compliance? Self-audit documentation kits for DME suppliers →

Building an AI agent? Try the agent API in the playground — free PA-required lookups, A4342 included, and starter credits via POST /bot-marketplace/register.