MyMedi-AI

A4604 — Tubing with integrated heating element for use with positive airway pressure device

HCPCS Level II A-code · short descriptor: “Tubing with heating element”

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
Inexpensive or routinely purchased
Prior authorization
Not on Medicare required-PA list
Face-to-face & WOPD
Not on the required 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.

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 (April 13, 2026 update — 83 items). The standard written order must reach the supplier before claim submission.

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

A4604 Medicare fee schedule (April 2026)

NU — New purchase Inexpensive or routinely purchased

Medicare allowable ranges from $49.31 to $76.79 depending on state and rural status.

StateNon-ruralRural
AK$68.58
AL$49.36$68.75
AR$49.36$68.75
AZ$49.52$68.75
CA$50.66$68.75
CO$50.59$68.75
CT$52.55$68.75
DC$49.98$68.75
DE$49.98$68.75
FL$49.36$68.75
GA$49.36$68.75
HI$68.58
IA$49.31$68.75
ID$50.59$68.75
IL$49.80$68.75
IN$49.80$68.75
KS$49.31$68.75
KY$49.36$68.75
LA$49.36$68.75
MA$52.55$68.75
MD$49.98$68.75
ME$52.55$68.75
MI$49.80$68.75
MN$49.31$68.75
MO$49.31$68.75
MS$49.36$68.75
MT$50.59$68.75
NC$49.36$68.75
ND$49.31$68.75
NE$49.31$68.75
NH$52.55$68.75
NJ$49.98$68.75
NM$49.52$68.75
NV$50.66$68.75
NY$49.98$68.75
OH$49.80$68.75
OK$49.52$68.75
OR$50.66$68.75
PA$49.98$68.75
PR$76.79
RI$52.55$68.75
SC$49.36$68.75
SD$49.31$68.75
TN$49.36$68.75
TX$49.52$68.75
UT$50.59$68.75
VA$49.36$68.75
VI$68.58
VT$52.55$68.75
WA$50.66$68.75
WI$49.80$68.75
WV$49.36$68.75
WY$50.59$68.75
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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