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
- 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.
A4604 Medicare fee schedule (October 2026)
NU — New purchase Inexpensive or routinely purchased
Medicare allowable ranges from $49.31 to $76.79 depending on state and rural status.
| State | Non-rural | Rural |
|---|---|---|
| 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 |
Unit limit (MUE)
Medicare's Medically Unlikely Edit caps A4604 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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