Key facts for A4450
- Medicare payment
- $0.10
- DMEPOS non-rural state fees (AU)
- Coverage code
- D
- special coverage instructions apply
- Practitioner MUE
- 0
- MAI 3
- NCCI PTP pairs
- 0
- practitioner file
- LCDs and articles
- 5 / 0
TL;DR
CMS describes HCPCS A4450, added in 2003, as "Tape, non-waterproof, per 18 square inches". A4450 is paid from the DMEPOS fee schedule as ostomy, tracheostomy and urological items (OS): AU (urological, ostomy or tracheostomy item) $0.10 in every contiguous state (floor $0.09, ceiling $0.10); AV (item with a prosthetic or orthotic device) $0.10 in every contiguous state (floor $0.09, ceiling $0.10); AW (item with a surgical dressing) $0.14 in every contiguous state (floor $0.12, ceiling $0.14), October 2026. MUE limits for A4450: practitioner 0 (MAI 3, CMS Policy); hospital outpatient 20 (MAI 3, Clinical: CMS Workgroup). 5 active LCDs list A4450: L33803 (Urological Supplies), L33828 (Ostomy Supplies). OPPS status indicator N: Items and Services packaged into APC rates. HCPCS record: BETOS D1F (prosthetic/orthotic devices); pricing indicator 37; type of service L (ESRD supplies), P (lump-sum purchase of DME, prosthetics or orthotics). 1 other active code opens with "Tape"; related codes: A4452, A4483, A4414, A4390.
A4450 descriptor and code status
The October 2026 HCPCS Level II file describes A4450 as “Tape, non-waterproof, per 18 square inches”. It sits in the A section (transportation, medical and surgical supplies, administrative, miscellaneous and investigational), listed with the other A codes.
| Field | Value |
|---|---|
| Short descriptor | Non-waterproof tape |
| Added to HCPCS | 2003-01-01 |
| Last action | N (no maintenance), effective 2003-01-01 |
| Coverage code | D: special coverage instructions apply |
| Pricing indicator | 37: DMEPOS ostomy, tracheostomy and urological supplies (floors and ceilings) |
| BETOS category | D1F: prosthetic/orthotic devices |
| Type of service | L: ESRD supplies; P: lump-sum purchase of DME, prosthetics or orthotics |
Medicare payment for A4450
A4450 is paid from the DMEPOS fee schedule as ostomy, tracheostomy and urological items (OS): AU (urological, ostomy or tracheostomy item) $0.10 in every contiguous state (floor $0.09, ceiling $0.10); AV (item with a prosthetic or orthotic device) $0.10 in every contiguous state (floor $0.09, ceiling $0.10); AW (item with a surgical dressing) $0.14 in every contiguous state (floor $0.12, ceiling $0.14), October 2026. The amounts below are national figures from the October 2026 CMS files; the contractor applies the locality, rural or state adjustment and the beneficiary's cost sharing.
Physician fee schedule (RVU26D)
Status X: statutory exclusion: not a physician service under the fee schedule. Global period XXX (global surgery concept does not apply); PC/TC indicator 9 (professional/technical concept does not apply).
DMEPOS fee schedule (DME26-D)
Jurisdiction D (DME MAC), payment category OS (ostomy, tracheostomy and urological items). Fees are set per state; AK, HI, PR and VI are not subject to the national ceiling and floor and are listed separately. A rural fee applies only in ZIP codes on the CMS rural ZIP list.
| Modifier | Floor / ceiling | Non-rural state range | Rural range | AK / HI / PR / VI |
|---|---|---|---|---|
| AU (urological, ostomy or tracheostomy item) | $0.09 / $0.10 | $0.10 (49 states) | — | AK $0.10, HI $0.10, PR $0.14, VI $0.10 |
| AV (item with a prosthetic or orthotic device) | $0.09 / $0.10 | $0.10 (49 states) | — | AK $0.10, HI $0.10, PR $0.14, VI $0.10 |
| AW (item with a surgical dressing) | $0.12 / $0.14 | $0.14 (49 states) | — | AK $0.14, HI $0.14, PR $0.16, VI $0.14 |
Hospital outpatient (OPPS Addendum B)
Status indicator N (Items and Services packaged into APC rates), with no separate OPPS payment rate.
Medically Unlikely Edits for A4450
MUE limits for A4450: practitioner 0 (MAI 3, CMS Policy); hospital outpatient 20 (MAI 3, Clinical: CMS Workgroup). The practitioner MUE is a date-of-service clinical edit: units above the limit deny but can be paid on appeal with documentation.
| Setting | MUE (units/DOS) | MAI | CMS rationale |
|---|---|---|---|
| Practitioner services | 0 | 3 Date of Service Edit: Clinical | CMS Policy |
| Facility outpatient hospital | 20 | 3 Date of Service Edit: Clinical | Clinical: CMS Workgroup |
The MUE lookup for A4450 shows every setting next to any other code on the same claim.
NCCI edits and add-on rules
No active practitioner PTP pair lists A4450 in v323r0.
A4450 is neither an add-on code nor a designated primary code in the 2026 Q4 NCCI add-on edit file.
Pair counts show exposure, not the answer for one claim. Check A4450 against a second code to see whether the pair bundles and whether a modifier can separate the services.
Medicare coverage policies for A4450
5 active Local Coverage Determinations and 0 billing and coding articles list A4450. Each applies only in its contractor's jurisdiction, and the article carries the diagnosis codes that support the item or service.
- Urological Supplies (L33803) · CGS Administrators, LLC; Noridian Healthcare Solutions, LLC
- LCD L33828: Ostomy Supplies · CGS Administrators, LLC; Noridian Healthcare Solutions, LLC
- Surgical Dressings, LCD L33831 · CGS Administrators, LLC; Noridian Healthcare Solutions, LLC
- Tracheostomy Care Supplies (L33832) · CGS Administrators, LLC; Noridian Healthcare Solutions, LLC
- L33738 Facial Prostheses · CGS Administrators, LLC; Noridian Healthcare Solutions, LLC
Denials to expect on A4450
the diagnosis or documentation does not meet the LCD or billing article that lists A4450
the AU, AV, AW payment modifier is missing or does not match the item
the claim lacks information needed to adjudicate the line, such as an order, NPI or required modifier
Where QuickIntell fits for A4450 claims
QuickAuth coordinates the requirement checks and documentation that DME claims for A4450 depend on, with human review of each case, and QuickRCM carries claim readiness and the CARC 50, 151 and modifier denials these items draw.
Frequently asked questions: HCPCS A4450
What does HCPCS code A4450 describe?
"Tape, non-waterproof, per 18 square inches" (short descriptor "Non-waterproof tape"), in the A section (transportation, medical and surgical supplies, administrative, miscellaneous and investigational). Added 2003-01-01.
Is A4450 a CPT code?
No: CMS maintains A4450 in HCPCS Level II, while the AMA maintains CPT. People do search "A4450 CPT code", and it goes in the same procedure-code field.
What does Medicare pay for A4450?
A4450 is paid from the DMEPOS fee schedule as ostomy, tracheostomy and urological items (OS): AU (urological, ostomy or tracheostomy item) $0.10 in every contiguous state (floor $0.09, ceiling $0.10); AV (item with a prosthetic or orthotic device) $0.10 in every contiguous state (floor $0.09, ceiling $0.10); AW (item with a surgical dressing) $0.14 in every contiguous state (floor $0.12, ceiling $0.14), October 2026.
How many units of A4450 can be billed per day?
MUE limits for A4450: practitioner 0 (MAI 3, CMS Policy); hospital outpatient 20 (MAI 3, Clinical: CMS Workgroup). For the practitioner MUE (MAI 3), units above 0 deny for the day but can be paid on appeal with documentation; denials arrive as CARC 151.
Does Medicare cover A4450?
Coverage code D (special coverage instructions apply). 5 active LCDs list A4450: L33803 (Urological Supplies), L33828 (Ostomy Supplies).
Sources
Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-10. Verify against the primary file before billing or contracting decisions. The reference methodology explains how each figure is computed from these files.
- HCPCS Level II alpha-numeric file, October 2026Version October 2026 · effective 2026-10-01 · file HCPC2026_OCT_ANWEB_09232026.txtSHA-256 c25240c63108756d…
- Medicare PFS national relative value file RVU26D (non-QPP), October 2026Version RVU26D, released 2026-08-26 · effective 2026-10-01 · file PPRRVU2026_Oct_nonQPP.csvSHA-256 4d0d3f19bd954ffc…
- Medicare PFS national relative value file RVU26D (qualifying APM participants), October 2026Version RVU26D, released 2026-08-26 · effective 2026-10-01 · file PPRRVU2026_Oct_QPP.csvSHA-256 59d3734704853936…
- DMEPOS fee schedule DME26-D, October 2026Version DME26-D (October 2026) · effective 2026-10-01 · file DMEPOS_OCT.csvSHA-256 a2824d58aadf4004…
- OPPS Addendum B, October 2026Version October 2026 · effective 2026-10-01 · file 508-compliant-version-2026_October_Web_Addendum_B.09.28.26.csvSHA-256 6ad7393a318bf1b9…
- Integrated Outpatient Code Editor v27.3 data tables: status and payment indicatorsVersion I/OCE v27.3 (October 2026) · effective 2026-10-01 · file Data_Status_Indicator.txtSHA-256 78f119ef0a435351…
- NCCI MUE table, practitioner services, effective 2026-10-01Version 2026 Q4 · effective 2026-10-01 · file MCR_MUE_PractitionerServices_Eff_10-01-2026.csvSHA-256 ef038efaf902b7bd…
- NCCI MUE table, facility services, effective 2026-10-01Version 2026 Q4 · effective 2026-10-01 · file MCR_MUE_OutpatientHospitalServices_Eff_10-01-2026.csvSHA-256 3af9f4e99cc587e2…
- NCCI MUE table, dme services, effective 2026-10-01Version 2026 Q4 · effective 2026-10-01 · file MCR_MUE_DMESupplierServices_Eff_10-01-2026.csvSHA-256 6fa4fbba852f7b74…
- NCCI PTP edits, practitioner, v323r0 (four files)Version v323r0 (2026 Q4) · effective 2026-10-01 · file ccipra-v323r0-f1.TXTSHA-256 7793c0b6686c1e22…
- Medicare Coverage Database, current LCD exportVersion MCD release 2026-10-08 · effective 2026-10-04 · file lcd.csvSHA-256 9aee1bd7f14056b0…
Disclaimer
This page is an operational reference compiled from CMS publications: the HCPCS Level II file, the physician, DMEPOS and clinical laboratory fee schedules, OPPS and ASC addenda, NCCI MUE, PTP and add-on edit tables and the Medicare Coverage Database. Amounts are Medicare national figures before locality and state adjustment; Medicaid and commercial payers set their own. CPT codes are shown as numbers only; CPT descriptors are copyright AMA. Nothing here is legal, clinical or billing advice.
Found a figure that does not match the CMS file? Report a data correction with the CMS file and the value you expected; the request reaches the editorial team through the contact form.