A4561 — Pessary, reusable, rubber, any type
HCPCS Level II A-code · short descriptor: “Pessary reusable rub anytype”
- 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.
A4561 Medicare fee schedule (April 2026)
Base (no modifier) Prosthetics & orthotics
Medicare allowable ranges from $28.43 to $29.45 depending on state and rural status.
Former-CBA payment limits: ceiling $34.73 · floor $26.05
| State | Non-rural | Rural |
|---|---|---|
| AL | $29.34 | — |
| AR | $29.33 | — |
| AZ | $28.43 | — |
| CA | $28.43 | — |
| CO | $29.45 | — |
| CT | $28.43 | — |
| DC | $28.43 | — |
| DE | $28.43 | — |
| FL | $29.34 | — |
| GA | $29.34 | — |
| IA | $29.02 | — |
| ID | $28.43 | — |
| IL | $29.21 | — |
| IN | $29.21 | — |
| KS | $29.02 | — |
| KY | $29.34 | — |
| LA | $29.33 | — |
| MA | $28.43 | — |
| MD | $28.43 | — |
| ME | $28.43 | — |
| MI | $29.21 | — |
| MN | $29.21 | — |
| MO | $29.02 | — |
| MS | $29.34 | — |
| MT | $29.45 | — |
| NC | $29.34 | — |
| ND | $29.45 | — |
| NE | $29.02 | — |
| NH | $28.43 | — |
| NJ | $28.43 | — |
| NM | $29.33 | — |
| NV | $28.43 | — |
| NY | $28.43 | — |
| OH | $29.21 | — |
| OK | $29.33 | — |
| OR | $28.43 | — |
| PA | $28.43 | — |
| RI | $28.43 | — |
| SC | $29.34 | — |
| SD | $29.45 | — |
| TN | $29.34 | — |
| TX | $29.33 | — |
| UT | $29.45 | — |
| VA | $28.43 | — |
| VT | $28.43 | — |
| WA | $28.43 | — |
| WI | $29.21 | — |
| WV | $28.43 | — |
| WY | $29.45 | — |
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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