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HCPCS A4638 · Level II · A code

A4638: Replacement battery for patient-owned ear pulse generator, each, 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 A4638

Medicare payment
no DMEPOS fee
DMEPOS category IN, no ceiling or state fee
Coverage code
C
carrier judgment, so the Medicare contractor decides coverage
DME supplier MUE
2
MAI 3
OPPS status
SI E1
Non-allowed item or service
NCCI PTP pairs
0
practitioner file
LCDs and articles
0 / 0

TL;DR

HCPCS Level II A4638 reads "Replacement battery for patient-owned ear pulse generator, each" in the October 2026 file; it dates from 2004. The October 2026 DMEPOS fee schedule lists A4638 in category IN (inexpensive and other routinely purchased items) without a ceiling, floor or state fee; its HCPCS pricing indicator is 32 (DMEPOS inexpensive and routinely purchased DME (floors and ceilings)). CMS caps A4638 at practitioner 0 (MAI 3, CMS Policy); hospital outpatient 0 (MAI 3, CMS Policy); DME supplier 2 (MAI 3, Clinical: Data) units per day in the 2026 Q4 MUE tables. No current LCD or billing article lists A4638; its HCPCS coverage code is C (carrier judgment, so the Medicare contractor decides coverage). OPPS status indicator E1: Non-allowed item or service. HCPCS record: BETOS D1E (other DME); pricing indicator 32; type of service P (lump-sum purchase of DME, prosthetics or orthotics). Nearby codes: A4641, A4630, A4649, A4615.

A4638 descriptor and code status

The October 2026 HCPCS Level II file describes A4638 as “Replacement battery for patient-owned ear pulse generator, each”. 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 A4638
FieldValue
Short descriptorRepl batt pulse gen sys
Added to HCPCS2004-01-01
Last actionN (no maintenance), effective 2004-01-01
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 A4638

The October 2026 DMEPOS fee schedule lists A4638 in category IN (inexpensive and other routinely purchased items) without a ceiling, floor or state fee; its HCPCS pricing indicator is 32 (DMEPOS inexpensive and routinely purchased DME (floors and ceilings)). 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 A4638 by modifier
ModifierFloor / ceilingNon-rural state rangeRural rangeAK / HI / PR / VI
NU (purchased, new)————
RR (rental)————
UE (purchased, used)————

Hospital outpatient (OPPS Addendum B)

Status indicator E1 (Non-allowed item or service), with no separate OPPS payment rate.

Medically Unlikely Edits for A4638

CMS caps A4638 at practitioner 0 (MAI 3, CMS Policy); hospital outpatient 0 (MAI 3, CMS Policy); DME supplier 2 (MAI 3, Clinical: Data) units per day in the 2026 Q4 MUE tables. 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 A4638 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services03 Date of Service Edit: ClinicalCMS Policy
Facility outpatient hospital03 Date of Service Edit: ClinicalCMS Policy
DME supplier23 Date of Service Edit: ClinicalClinical: Data

The MUE lookup for A4638 shows every setting next to any other code on the same claim.

NCCI edits and add-on rules

No active practitioner PTP pair lists A4638 in v323r0.

A4638 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 A4638 against a second code to see whether the pair bundles and whether a modifier can separate the services.

Medicare coverage policies for A4638

No current LCD or billing and coding article lists A4638. 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 A4638

CARC 50 · N115

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

CARC 151 · N362

units of A4638 exceed the DME supplier MUE of 2 per date of service

CARC 4

the NU, RR, UE 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

For teams evaluating QuickIntell software

Where QuickIntell fits for A4638 claims

QuickAuth coordinates the requirement checks and documentation that DME claims for A4638 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-up
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Optional software evaluation, not payer support or help with an individual claim. For coverage or payment decisions, use the official sources on this page. Do not include patient information in a demo booking or inquiry.

Frequently asked questions: HCPCS A4638

What does HCPCS code A4638 describe?

"Replacement battery for patient-owned ear pulse generator, each" (short descriptor "Repl batt pulse gen sys"), in the A section (transportation, medical and surgical supplies, administrative, miscellaneous and investigational). Added 2004-01-01.

Is A4638 a CPT code?

It is not. A4638 belongs to the A section (transportation, medical and surgical supplies, administrative, miscellaneous and investigational) of HCPCS Level II, the CMS code set, not to AMA CPT.

What does Medicare pay for A4638?

The October 2026 DMEPOS fee schedule lists A4638 in category IN (inexpensive and other routinely purchased items) without a ceiling, floor or state fee; its HCPCS pricing indicator is 32 (DMEPOS inexpensive and routinely purchased DME (floors and ceilings)).

How many units of A4638 can be billed per day?

CMS caps A4638 at practitioner 0 (MAI 3, CMS Policy); hospital outpatient 0 (MAI 3, CMS Policy); DME supplier 2 (MAI 3, Clinical: Data) units per day in the 2026 Q4 MUE tables. For the DME supplier MUE (MAI 3), units above 2 deny for the day but can be paid on appeal with documentation; denials arrive as CARC 151.

Does Medicare cover A4638?

No current LCD or billing article lists A4638; its HCPCS coverage code is C (carrier judgment, so the Medicare contractor decides coverage).

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.