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HCPCS A4604 · Level II · A code

A4604: Tubing with integrated heating element for use with positive airway pressure device, 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); Medicare Coverage Database LCD export: MCD release October 8, 2026 (effective October 4, 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; weekly, every Thursday for the Medicare Coverage Database LCD export.

Key facts for A4604

Medicare payment
$49.31 to $52.55
DMEPOS non-rural state fees (NU)
Coverage code
C
carrier judgment, so the Medicare contractor decides coverage
DME supplier MUE
1
MAI 2
OPPS status
SI N
Items and Services packaged into APC rates
NCCI PTP pairs
0
practitioner file
LCDs and articles
2 / 0

TL;DR

A4604 is a Level II code from the A section (transportation, medical and surgical supplies, administrative, miscellaneous and investigational), in use since 2006: "Tubing with integrated heating element for use with positive airway pressure device". A4604 is paid from the DMEPOS fee schedule as inexpensive and other routinely purchased items (IN): NU (purchased, new) $49.31 in IA, KS, MN and 4 more to $52.55 in CT, MA, ME and 3 more, rural $68.75, October 2026. MUE limits for A4604: practitioner 0 (MAI 3, CMS Policy); hospital outpatient 1 (MAI 3, Clinical: CMS Workgroup); DME supplier 1 (MAI 2, Published Contractor Policy). 2 active LCDs list A4604: L33718 (Positive Airway Pressure (PAP) Devices for the Treatment of Obstructive Sleep Apnea), L33800 (Respiratory Assist Devices). OPPS status indicator N: Items and Services packaged into APC rates. HCPCS record: BETOS D1E (other DME); pricing indicator 32; type of service P (lump-sum purchase of DME, prosthetics or orthotics). Nearby codes: A4595, A4615, A4630, A4575.

A4604 descriptor and code status

The October 2026 HCPCS Level II file describes A4604 as “Tubing with integrated heating element for use with positive airway pressure device”. It sits in the A section (transportation, medical and surgical supplies, administrative, miscellaneous and investigational), listed with the other A codes. Although searches often call it the "A4604 CPT code", A4604 is a HCPCS Level II code maintained by CMS, not an AMA CPT code; both go in the same procedure-code field on the claim.

HCPCS file attributes of A4604
FieldValue
Short descriptorTubing with heating element
Added to HCPCS2006-01-01
Last actionN (no maintenance), effective 2006-01-01
Coverage codeC: carrier judgment, so the Medicare contractor decides coverage
Pricing indicator32: DMEPOS inexpensive and routinely purchased DME (floors and ceilings)
BETOS categoryD1E: other DME
Type of serviceP: lump-sum purchase of DME, prosthetics or orthotics

Medicare payment for A4604

A4604 is paid from the DMEPOS fee schedule as inexpensive and other routinely purchased items (IN): NU (purchased, new) $49.31 in IA, KS, MN and 4 more to $52.55 in CT, MA, ME and 3 more, rural $68.75, 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 IN (inexpensive and other routinely purchased 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.

DMEPOS fees for A4604 by modifier
ModifierFloor / ceilingNon-rural state rangeRural rangeAK / HI / PR / VI
NU (purchased, new)—$49.31 (IA, KS, MN…) to $52.55 (CT, MA, ME…)$68.75 (49 states)AK $68.58, HI $68.58, PR $76.79, VI $68.58

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 A4604

MUE limits for A4604: practitioner 0 (MAI 3, CMS Policy); hospital outpatient 1 (MAI 3, Clinical: CMS Workgroup); DME supplier 1 (MAI 2, Published Contractor Policy). The DME supplier MUE is a date-of-service policy edit: units above the limit deny even when split across lines, and appeals rarely succeed.

MUE values for A4604 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services03 Date of Service Edit: ClinicalCMS Policy
Facility outpatient hospital13 Date of Service Edit: ClinicalClinical: CMS Workgroup
DME supplier12 Date of Service Edit: PolicyPublished Contractor Policy

The MUE lookup for A4604 shows every setting next to any other code on the same claim.

NCCI edits and add-on rules

No active practitioner PTP pair lists A4604 in v323r0.

A4604 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 A4604 against a second code to see whether the pair bundles and whether a modifier can separate the services.

Medicare coverage policies for A4604

2 active Local Coverage Determinations and 0 billing and coding articles list A4604. Each applies only in its contractor's jurisdiction, and the article carries the diagnosis codes that support the item or service.

Denials to expect on A4604

CARC 50 · N115

the diagnosis or documentation does not meet the LCD or billing article that lists A4604

CARC 151 · N362

units of A4604 exceed the DME supplier MUE of 1 per date of service

CARC 4

the NU payment modifier is missing or does not match the item

CARC 16

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

Where QuickIntell fits for A4604 claims

QuickAuth coordinates the requirement checks and documentation that DME claims for A4604 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 A4604

What does HCPCS code A4604 describe?

"Tubing with integrated heating element for use with positive airway pressure device" (short descriptor "Tubing with heating element"), in the A section (transportation, medical and surgical supplies, administrative, miscellaneous and investigational). Added 2006-01-01.

Is A4604 a CPT code?

No: CMS maintains A4604 in HCPCS Level II, while the AMA maintains CPT. People do search "A4604 CPT code", and it goes in the same procedure-code field.

What does Medicare pay for A4604?

A4604 is paid from the DMEPOS fee schedule as inexpensive and other routinely purchased items (IN): NU (purchased, new) $49.31 in IA, KS, MN and 4 more to $52.55 in CT, MA, ME and 3 more, rural $68.75, October 2026.

How many units of A4604 can be billed per day?

MUE limits for A4604: practitioner 0 (MAI 3, CMS Policy); hospital outpatient 1 (MAI 3, Clinical: CMS Workgroup); DME supplier 1 (MAI 2, Published Contractor Policy). For the DME supplier MUE (MAI 2), units above 1 deny for the whole day as a policy limit; denials arrive as CARC 151.

Does Medicare cover A4604?

Coverage code C (carrier judgment, so the Medicare contractor decides coverage). 2 active LCDs list A4604: L33718 (Positive Airway Pressure (PAP) Devices for the Treatment of Obstructive Sleep Apnea), L33800 (Respiratory Assist Devices).

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.