A7028 — Oral cushion for combination oral/nasal mask, replacement only, each
HCPCS Level II A-code · short descriptor: “Repl oral cushion combo mask”
- 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
- 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.
A7028 Medicare fee schedule (April 2026)
NU — New purchase Inexpensive or routinely purchased
Medicare allowable ranges from $40.30 to $66.05 depending on state and rural status.
| State | Non-rural | Rural |
|---|---|---|
| AK | $58.99 | — |
| AL | $42.97 | $58.64 |
| AR | $42.97 | $58.64 |
| AZ | $40.86 | $58.64 |
| CA | $41.72 | $58.64 |
| CO | $41.64 | $58.64 |
| CT | $41.59 | $58.64 |
| DC | $40.30 | $58.64 |
| DE | $40.30 | $58.64 |
| FL | $42.97 | $58.64 |
| GA | $42.97 | $58.64 |
| HI | $58.99 | — |
| IA | $43.48 | $58.64 |
| ID | $41.64 | $58.64 |
| IL | $43.27 | $58.64 |
| IN | $43.27 | $58.64 |
| KS | $43.48 | $58.64 |
| KY | $42.97 | $58.64 |
| LA | $42.97 | $58.64 |
| MA | $41.59 | $58.64 |
| MD | $40.30 | $58.64 |
| ME | $41.59 | $58.64 |
| MI | $43.27 | $58.64 |
| MN | $43.48 | $58.64 |
| MO | $43.48 | $58.64 |
| MS | $42.97 | $58.64 |
| MT | $41.64 | $58.64 |
| NC | $42.97 | $58.64 |
| ND | $43.48 | $58.64 |
| NE | $43.48 | $58.64 |
| NH | $41.59 | $58.64 |
| NJ | $40.30 | $58.64 |
| NM | $40.86 | $58.64 |
| NV | $41.72 | $58.64 |
| NY | $40.30 | $58.64 |
| OH | $43.27 | $58.64 |
| OK | $40.86 | $58.64 |
| OR | $41.72 | $58.64 |
| PA | $40.30 | $58.64 |
| PR | $66.05 | — |
| RI | $41.59 | $58.64 |
| SC | $42.97 | $58.64 |
| SD | $43.48 | $58.64 |
| TN | $42.97 | $58.64 |
| TX | $40.86 | $58.64 |
| UT | $41.64 | $58.64 |
| VA | $42.97 | $58.64 |
| VI | $58.99 | — |
| VT | $41.59 | $58.64 |
| WA | $41.72 | $58.64 |
| WI | $43.27 | $58.64 |
| WV | $42.97 | $58.64 |
| WY | $41.64 | $58.64 |
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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