A7040 — One way chest drain valve
HCPCS Level II A-code
- 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
- Prosthetics & orthotics
- 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.
A7040 Medicare fee schedule (April 2026)
Base (no modifier) Prosthetics & orthotics
Medicare allowable ranges from $56.24 to $58.41 depending on state and rural status.
Former-CBA payment limits: ceiling $68.67 · floor $51.50
| State | Non-rural | Rural |
|---|---|---|
| AL | $57.96 | — |
| AR | $57.96 | — |
| AZ | $56.24 | — |
| CA | $56.24 | — |
| CO | $58.41 | — |
| CT | $56.24 | — |
| DC | $56.24 | — |
| DE | $56.24 | — |
| FL | $57.96 | — |
| GA | $57.96 | — |
| IA | $57.36 | — |
| ID | $56.24 | — |
| IL | $57.63 | — |
| IN | $57.63 | — |
| KS | $57.36 | — |
| KY | $57.96 | — |
| LA | $57.96 | — |
| MA | $56.24 | — |
| MD | $56.24 | — |
| ME | $56.24 | — |
| MI | $57.63 | — |
| MN | $57.63 | — |
| MO | $57.36 | — |
| MS | $57.96 | — |
| MT | $58.41 | — |
| NC | $57.96 | — |
| ND | $58.41 | — |
| NE | $57.36 | — |
| NH | $56.24 | — |
| NJ | $56.24 | — |
| NM | $57.96 | — |
| NV | $56.24 | — |
| NY | $56.24 | — |
| OH | $57.63 | — |
| OK | $57.96 | — |
| OR | $56.24 | — |
| PA | $56.24 | — |
| RI | $56.24 | — |
| SC | $57.96 | — |
| SD | $58.41 | — |
| TN | $57.96 | — |
| TX | $57.96 | — |
| UT | $58.41 | — |
| VA | $56.24 | — |
| VT | $56.24 | — |
| WA | $56.24 | — |
| WI | $57.63 | — |
| WV | $56.24 | — |
| WY | $58.41 | — |
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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