A4617 — Mouth piece
HCPCS Level II A-code
- Code system
- HCPCS Level II
- Family
- A — Medical & surgical supplies, ambulance
- Medicare coverage status
- Special coverage instructions apply
- DMEPOS payment category
- Supplies
- 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.
A4617 Medicare fee schedule (April 2026)
Base (no modifier) Supplies
Medicare allowable ranges from $4.42 to $5.28 depending on state and rural status.
Former-CBA payment limits: ceiling $4.42 · floor $3.76
| State | Non-rural | Rural |
|---|---|---|
| AK | $4.42 | — |
| AL | $4.42 | — |
| AR | $4.42 | — |
| AZ | $4.42 | — |
| CA | $4.42 | — |
| CO | $4.42 | — |
| CT | $4.42 | — |
| DC | $4.42 | — |
| DE | $4.42 | — |
| FL | $4.42 | — |
| GA | $4.42 | — |
| HI | $4.42 | — |
| IA | $4.42 | — |
| ID | $4.42 | — |
| IL | $4.42 | — |
| IN | $4.42 | — |
| KS | $4.42 | — |
| KY | $4.42 | — |
| LA | $4.42 | — |
| MA | $4.42 | — |
| MD | $4.42 | — |
| ME | $4.42 | — |
| MI | $4.42 | — |
| MN | $4.42 | — |
| MO | $4.42 | — |
| MS | $4.42 | — |
| MT | $4.42 | — |
| NC | $4.42 | — |
| ND | $4.42 | — |
| NE | $4.42 | — |
| NH | $4.42 | — |
| NJ | $4.42 | — |
| NM | $4.42 | — |
| NV | $4.42 | — |
| NY | $4.42 | — |
| OH | $4.42 | — |
| OK | $4.42 | — |
| OR | $4.42 | — |
| PA | $4.42 | — |
| PR | $5.28 | — |
| RI | $4.42 | — |
| SC | $4.42 | — |
| SD | $4.42 | — |
| TN | $4.42 | — |
| TX | $4.42 | — |
| UT | $4.42 | — |
| VA | $4.42 | — |
| VI | $4.42 | — |
| VT | $4.42 | — |
| WA | $4.42 | — |
| WI | $4.42 | — |
| WV | $4.42 | — |
| WY | $4.42 | — |
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
Bill A4617 with confidence
MyMedi-AI scrubs whole claims against NCCI pairs, MUE limits, modifier rules, and PA flags before you submit — built for DME teams, no PHI stored on our servers.
Start free trial Run a CMS-0057-F readiness checkPrefer DIY compliance? Self-audit documentation kits for DME suppliers →