A4562 — Pessary, reusable, non rubber, any type
HCPCS Level II A-code · short descriptor: “Pessary reusable nonrubber”
- 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.
A4562 Medicare fee schedule (April 2026)
Base (no modifier) Prosthetics & orthotics
Medicare allowable ranges from $70.81 to $73.34 depending on state and rural status.
Former-CBA payment limits: ceiling $86.42 · floor $64.82
| State | Non-rural | Rural |
|---|---|---|
| AL | $72.96 | — |
| AR | $72.96 | — |
| AZ | $70.81 | — |
| CA | $70.81 | — |
| CO | $73.34 | — |
| CT | $70.81 | — |
| DC | $70.81 | — |
| DE | $70.81 | — |
| FL | $72.96 | — |
| GA | $72.96 | — |
| IA | $72.18 | — |
| ID | $70.81 | — |
| IL | $72.57 | — |
| IN | $72.57 | — |
| KS | $72.18 | — |
| KY | $72.96 | — |
| LA | $72.96 | — |
| MA | $70.81 | — |
| MD | $70.81 | — |
| ME | $70.81 | — |
| MI | $72.57 | — |
| MN | $72.57 | — |
| MO | $72.18 | — |
| MS | $72.96 | — |
| MT | $73.34 | — |
| NC | $72.96 | — |
| ND | $73.34 | — |
| NE | $72.18 | — |
| NH | $70.81 | — |
| NJ | $70.81 | — |
| NM | $72.96 | — |
| NV | $70.81 | — |
| NY | $70.81 | — |
| OH | $72.57 | — |
| OK | $72.96 | — |
| OR | $70.81 | — |
| PA | $70.81 | — |
| RI | $70.81 | — |
| SC | $72.96 | — |
| SD | $73.34 | — |
| TN | $72.96 | — |
| TX | $72.96 | — |
| UT | $73.34 | — |
| VA | $70.81 | — |
| VT | $70.81 | — |
| WA | $70.81 | — |
| WI | $72.57 | — |
| WV | $70.81 | — |
| WY | $73.34 | — |
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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