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HCPCS A4561 · Level II · A code

A4561: Pessary, reusable, rubber, any type, HCPCS Level II A code

Compiled from CMS files by the QuickIntell RCM Editorial Team · Data effective · Method: reference methodology · Report a data correction

Data currency: HCPCS Level II file: October 2026 (effective October 1, 2026); PFS relative value file: RVU26D, released August 26, 2026 (effective October 1, 2026); DMEPOS fee schedule: DME26-D (October 2026) (effective October 1, 2026); NCCI MUE tables: 2026 Q4 (effective October 1, 2026); NCCI PTP edits: v323r0 (2026 Q4) (effective October 1, 2026); OPPS Addendum B: October 2026 (effective October 1, 2026). Next CMS release: January 1, 2027 (quarterly update) for the HCPCS Level II file and DMEPOS fee schedule and NCCI MUE tables and NCCI PTP edits and OPPS Addendum B; RVU27A with the CY2027 PFS final rule, effective January 1, 2027 for the PFS relative value file.

Key facts for A4561

Medicare payment
$28.43 to $29.45
DMEPOS non-rural state fees
Coverage code
C
carrier judgment, so the Medicare contractor decides coverage
DME supplier MUE
0
MAI 3
OPPS status
SI N
Items and Services packaged into APC rates
NCCI PTP pairs
0
practitioner file
LCDs and articles
0 / 0

TL;DR

HCPCS Level II A4561 reads "Pessary, reusable, rubber, any type" in the October 2026 file; it dates from 2001. DMEPOS fees for A4561, a PO (prosthetics and orthotics) item, run $28.43 in AZ, CA, CT and 17 more to $29.45 in CO, MT, ND and 3 more (floor $26.05, ceiling $34.73) in the October 2026 file. Its 2026 Q4 MUEs per date of service: practitioner 1 (MAI 3, Nature of Equipment); hospital outpatient 1 (MAI 3, Nature of Equipment); DME supplier 0 (MAI 3, CMS Policy). A4561 appears in no active LCD or billing and coding article, so coverage follows HCPCS coverage code C (carrier judgment, so the Medicare contractor decides coverage) and any NCD. OPPS status indicator N: Items and Services packaged into APC rates. HCPCS record: BETOS D1F (prosthetic/orthotic devices); pricing indicator 38; type of service P (lump-sum purchase of DME, prosthetics or orthotics). 2 other active codes open with "Pessary"; related codes: A4562, A4564, A4558, A4557.

A4561 descriptor and code status

The October 2026 HCPCS Level II file describes A4561 as “Pessary, reusable, rubber, any type”. It sits in the A section (transportation, medical and surgical supplies, administrative, miscellaneous and investigational), listed with the other A codes.

HCPCS file attributes of A4561
FieldValue
Short descriptorPessary reusable rub anytype
Added to HCPCS2001-01-01
Last actionN (no maintenance), effective 2024-04-01
Coverage codeC: carrier judgment, so the Medicare contractor decides coverage
Pricing indicator38: DMEPOS orthotics, prosthetics, prosthetic devices and vision services (floors and ceilings)
BETOS categoryD1F: prosthetic/orthotic devices
Type of serviceP: lump-sum purchase of DME, prosthetics or orthotics

Medicare payment for A4561

DMEPOS fees for A4561, a PO (prosthetics and orthotics) item, run $28.43 in AZ, CA, CT and 17 more to $29.45 in CO, MT, ND and 3 more (floor $26.05, ceiling $34.73) in the October 2026 file. 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 L (local Part B MAC), payment category PO (prosthetics and orthotics). 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.

DMEPOS fees for A4561 by modifier
ModifierFloor / ceilingNon-rural state rangeRural rangeAK / HI / PR / VI
none$26.05 / $34.73$28.43 (AZ, CA, CT…) to $29.45 (CO, MT, ND…)——

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 A4561

Its 2026 Q4 MUEs per date of service: practitioner 1 (MAI 3, Nature of Equipment); hospital outpatient 1 (MAI 3, Nature of Equipment); DME supplier 0 (MAI 3, CMS Policy). The DME supplier MUE is a date-of-service clinical edit: units above the limit deny but can be paid on appeal with documentation.

MUE values for A4561 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services13 Date of Service Edit: ClinicalNature of Equipment
Facility outpatient hospital13 Date of Service Edit: ClinicalNature of Equipment
DME supplier03 Date of Service Edit: ClinicalCMS Policy

The MUE lookup for A4561 shows every setting next to any other code on the same claim.

NCCI edits and add-on rules

No active practitioner PTP pair lists A4561 in v323r0.

A4561 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 A4561 against a second code to see whether the pair bundles and whether a modifier can separate the services.

Medicare coverage policies for A4561

No current LCD or billing and coding article lists A4561. The HCPCS coverage code C means carrier judgment, so the Medicare contractor decides coverage, and any National Coverage Determination for the service still applies.

Denials to expect on A4561

CARC 50 · N115

the service is not reasonable and necessary for the diagnosis on the claim

CARC 151 · N362

units of A4561 exceed the DME supplier MUE of 0 per date of service

CARC 4

the modifier reported is inconsistent with the code

CARC 16

the claim lacks information needed to adjudicate the line, such as an order, NPI or required modifier

Where QuickIntell fits for A4561 claims

QuickAuth coordinates the requirement checks and documentation that DME claims for A4561 depend on, with human review of each case, and QuickRCM carries claim readiness and the CARC 50, 151 and modifier denials these items draw.

See QuickAuth for requirement checksSee QuickRCM for denial follow-upBook a meeting

Frequently asked questions: HCPCS A4561

What does HCPCS code A4561 describe?

"Pessary, reusable, rubber, any type" (short descriptor "Pessary reusable rub anytype"), in the A section (transportation, medical and surgical supplies, administrative, miscellaneous and investigational). Added 2001-01-01; last action N (no maintenance) effective 2024-04-01.

Is A4561 a CPT code?

No. A4561 is a CMS HCPCS Level II code; CPT codes are the AMA's five-character set.

What does Medicare pay for A4561?

DMEPOS fees for A4561, a PO (prosthetics and orthotics) item, run $28.43 in AZ, CA, CT and 17 more to $29.45 in CO, MT, ND and 3 more (floor $26.05, ceiling $34.73) in the October 2026 file.

How many units of A4561 can be billed per day?

Its 2026 Q4 MUEs per date of service: practitioner 1 (MAI 3, Nature of Equipment); hospital outpatient 1 (MAI 3, Nature of Equipment); DME supplier 0 (MAI 3, CMS Policy). For the DME supplier 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 A4561?

A4561 appears in no active LCD or billing and coding article, so coverage follows HCPCS coverage code C (carrier judgment, so the Medicare contractor decides coverage) and any NCD.

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.

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.