MyMedi-AI

A7036 — Chinstrap used with positive airway pressure device

HCPCS Level II A-code · short descriptor: “Pos airway press chinstrap”

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 2026-10-16; 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 2026-10-16; 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.

A7036 Medicare fee schedule (October 2026)

NU — New purchase Inexpensive or routinely purchased

Medicare allowable ranges from $12.95 to $18.52 depending on state and rural status.

StateNon-ruralRural
AK$15.30—
AL$13.32$17.11
AR$13.32$17.02
AZ$13.00$18.52
CA$13.70$18.52
CO$13.08$17.07
CT$13.80$18.52
DC$12.95$16.84
DE$12.95$18.52
FL$13.32$16.84
GA$13.32$16.84
HI$15.87—
IA$12.97$18.52
ID$13.08$18.52
IL$13.58$16.84
IN$13.58$16.87
KS$12.97$18.52
KY$13.32$16.93
LA$13.32$17.29
MA$13.80$18.52
MD$12.95$16.84
ME$13.80$18.52
MI$13.58$16.84
MN$12.97$16.95
MO$12.97$18.52
MS$13.32$17.02
MT$13.08$18.52
NC$13.32$16.84
ND$12.97$18.52
NE$12.97$18.52
NH$13.80$18.52
NJ$12.95$18.52
NM$13.00$16.97
NV$13.70$18.52
NY$12.95$18.52
OH$13.58$16.84
OK$13.00$16.96
OR$13.70$18.52
PA$12.95$18.52
PR$18.25—
RI$13.80$18.52
SC$13.32$16.93
SD$12.97$18.52
TN$13.32$17.18
TX$13.00$16.84
UT$13.08$18.52
VA$13.32$16.84
VI$18.48—
VT$13.80$18.52
WA$13.70$18.52
WI$13.58$16.87
WV$13.32$16.84
WY$13.08$18.52
Amounts are the Medicare DMEPOS fee-schedule allowables effective October 2026 (CMS DMEPOS Fee Schedule October 2026 (DME26-D)). 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.

Unit limit (MUE)

Medicare's Medically Unlikely Edit caps A7036 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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