A4459 — Manual transanal irrigation system, includes water reservoir, pump, tubing, and accessories, without catheter, any type
HCPCS Level II A-code · short descriptor: “Transanal irrigation, any”
- 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
- Prosthetics & orthotics
- Prior authorization
- Not on Medicare required-PA list
- Status
- Active (April 2026 HCPCS)
Prior authorization
Not on the Medicare required-PA list as of the January 13, 2026 update (74 items). Medicare Advantage and commercial plans set their own prior-authorization rules for this code — verify per plan before delivery.
A4459 Medicare fee schedule (April 2026)
Base (no modifier) Prosthetics & orthotics
Medicare allowable: $160.42 in all listed states.
Former-CBA payment limits: ceiling $192.50 · floor $144.38
| State | Non-rural | Rural |
|---|---|---|
| AK | $160.42 | — |
| AL | $160.42 | — |
| AR | $160.42 | — |
| AZ | $160.42 | — |
| CA | $160.42 | — |
| CO | $160.42 | — |
| CT | $160.42 | — |
| DC | $160.42 | — |
| DE | $160.42 | — |
| FL | $160.42 | — |
| GA | $160.42 | — |
| HI | $160.42 | — |
| IA | $160.42 | — |
| ID | $160.42 | — |
| IL | $160.42 | — |
| IN | $160.42 | — |
| KS | $160.42 | — |
| KY | $160.42 | — |
| LA | $160.42 | — |
| MA | $160.42 | — |
| MD | $160.42 | — |
| ME | $160.42 | — |
| MI | $160.42 | — |
| MN | $160.42 | — |
| MO | $160.42 | — |
| MS | $160.42 | — |
| MT | $160.42 | — |
| NC | $160.42 | — |
| ND | $160.42 | — |
| NE | $160.42 | — |
| NH | $160.42 | — |
| NJ | $160.42 | — |
| NM | $160.42 | — |
| NV | $160.42 | — |
| NY | $160.42 | — |
| OH | $160.42 | — |
| OK | $160.42 | — |
| OR | $160.42 | — |
| PA | $160.42 | — |
| PR | $160.42 | — |
| RI | $160.42 | — |
| SC | $160.42 | — |
| SD | $160.42 | — |
| TN | $160.42 | — |
| TX | $160.42 | — |
| UT | $160.42 | — |
| VA | $160.42 | — |
| VI | $160.42 | — |
| VT | $160.42 | — |
| WA | $160.42 | — |
| WI | $160.42 | — |
| WV | $160.42 | — |
| WY | $160.42 | — |
Amounts are the Medicare DMEPOS fee-schedule allowables effective April 2026.
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.
Common denial codes to watch
Related A-codes
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