MyMedi-AI

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
Face-to-face & WOPD
Not on the required list
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.

A7040 Medicare fee schedule (October 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

StateNon-ruralRural
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 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.

Common denial codes to watch

Related A-codes

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