MyMedi-AI

A4356 — External urethral clamp or compression device (not to be used for catheter clamp), each

HCPCS Level II A-code · short descriptor: “Ext ureth clmp or compr dvc”

Code system
HCPCS Level II
Family
A — Medical & surgical supplies, ambulance
Medicare coverage status
Special coverage instructions apply
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
1
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 2026-10-25; 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 2026-10-25; 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.

A4356 Medicare fee schedule (October 2026)

Base (no modifier) Ostomy, tracheostomy & urological supplies

Medicare allowable ranges from $46.97 to $79.51 depending on state and rural status.

Former-CBA payment limits: ceiling $65.03 · floor $55.28

StateNon-ruralRural
AK$74.39—
AL$65.03—
AR$65.03—
AZ$61.00—
CA$65.03—
CO$55.28—
CT$65.03—
DC$65.03—
DE$65.03—
FL$65.03—
GA$65.03—
HI$79.51—
IA$61.76—
ID$55.28—
IL$65.03—
IN$65.03—
KS$64.36—
KY$65.03—
LA$65.03—
MA$55.28—
MD$63.71—
ME$55.28—
MI$65.03—
MN$65.03—
MO$65.03—
MS$59.30—
MT$61.76—
NC$64.65—
ND$65.03—
NE$62.34—
NH$55.28—
NJ$65.03—
NM$65.03—
NV$56.08—
NY$55.28—
OH$65.03—
OK$55.28—
OR$60.48—
PA$65.03—
PR$46.97—
RI$55.28—
SC$60.05—
SD$65.03—
TN$65.03—
TX$55.28—
UT$65.03—
VA$55.28—
VI$55.28—
VT$55.28—
WA$55.28—
WI$65.03—
WV$65.03—
WY$55.28—
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 A4356 at 1 unit per date of service (absolute). Units above the MUE deny — typically as CO-151. Rationale: Published Contractor Policy.

Common denial codes to watch

Related A-codes

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