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HCPCS A4640 · Level II · A code

A4640: Replacement pad for use with medically necessary alternating pressure pad owned by patient, 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 A4640

Medicare payment
$58.10 to $72.47
DMEPOS non-rural state fees (NU)
Coverage code
D
special coverage instructions apply
DME supplier MUE
1
MAI 2
OPPS status
SI E1
Non-allowed item or service
NCCI PTP pairs
0
practitioner file
LCDs and articles
1 / 0

TL;DR

CMS describes HCPCS A4640, added in 1991, as "Replacement pad for use with medically necessary alternating pressure pad owned by patient". A4640 is paid from the DMEPOS fee schedule as inexpensive and other routinely purchased items (IN): NU (purchased, new) $58.10 in CA, NV, OR and 1 more to $72.47 in CT, MA, ME and 3 more, rural $74.59 to $81.35; RR (rental) $5.81 in CA, NV, OR and 1 more to $7.25 in CT, MA, ME and 3 more, rural $7.53 to $8.22; UE (purchased, used) $43.58 in CA, NV, OR and 1 more to $54.35 in CT, MA, ME and 3 more, rural $54.35 to $59.15, October 2026. MUE limits for A4640: practitioner 0 (MAI 3, CMS Policy); hospital outpatient 0 (MAI 3, CMS Policy); DME supplier 1 (MAI 2, Code Descriptor / CPT Instruction). 1 active LCD lists A4640: L33830 (Pressure Reducing Support Surfaces - Group 1). OPPS status indicator E1: Non-allowed item or service. HCPCS record: BETOS D1E (other DME); pricing indicator 32; type of service A (used DME), P (lump-sum purchase of DME, prosthetics or orthotics), R (rental of DME). Nearby codes: A4641, A4649, A4630, A4615.

A4640 descriptor and code status

The October 2026 HCPCS Level II file describes A4640 as “Replacement pad for use with medically necessary alternating pressure pad owned by patient”. 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 A4640
FieldValue
Short descriptorAlternating pressure pad
Added to HCPCS1991-01-01
Last actionN (no maintenance), effective 1991-01-01
Coverage codeD: special coverage instructions apply
Pricing indicator32: DMEPOS inexpensive and routinely purchased DME (floors and ceilings)
BETOS categoryD1E: other DME
Type of serviceA: used DME; P: lump-sum purchase of DME, prosthetics or orthotics; R: rental of DME

Medicare payment for A4640

A4640 is paid from the DMEPOS fee schedule as inexpensive and other routinely purchased items (IN): NU (purchased, new) $58.10 in CA, NV, OR and 1 more to $72.47 in CT, MA, ME and 3 more, rural $74.59 to $81.35; RR (rental) $5.81 in CA, NV, OR and 1 more to $7.25 in CT, MA, ME and 3 more, rural $7.53 to $8.22; UE (purchased, used) $43.58 in CA, NV, OR and 1 more to $54.35 in CT, MA, ME and 3 more, rural $54.35 to $59.15, 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 A4640 by modifier
ModifierFloor / ceilingNon-rural state rangeRural rangeAK / HI / PR / VI
NU (purchased, new)—$58.10 (CA, NV, OR…) to $72.47 (CT, MA, ME…)$74.59 (AR, AZ, DC…) to $81.35 (AL, CO, CT…)AK $79.69, HI $82.51, PR $93.30, VI $78.69
RR (rental)—$5.81 (CA, NV, OR…) to $7.25 (CT, MA, ME…)$7.53 (CA, DC, DE…) to $8.22 (AL, AZ, CO…)AK $6.88, HI $7.36, PR $10.69, VI $8.05
UE (purchased, used)—$43.58 (CA, NV, OR…) to $54.35 (CT, MA, ME…)$54.35 (AZ, DC, DE…) to $59.15 (AL, CO, CT…)AK $59.79, HI $61.88, PR $69.96, VI $57.57

Hospital outpatient (OPPS Addendum B)

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

Medically Unlikely Edits for A4640

MUE limits for A4640: practitioner 0 (MAI 3, CMS Policy); hospital outpatient 0 (MAI 3, CMS Policy); DME supplier 1 (MAI 2, Code Descriptor / CPT Instruction). 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 A4640 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 supplier12 Date of Service Edit: PolicyCode Descriptor / CPT Instruction

The MUE lookup for A4640 shows every setting next to any other code on the same claim.

NCCI edits and add-on rules

No active practitioner PTP pair lists A4640 in v323r0.

A4640 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 A4640 against a second code to see whether the pair bundles and whether a modifier can separate the services.

Medicare coverage policies for A4640

1 active Local Coverage Determination and 0 billing and coding articles list A4640. 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 A4640

CARC 50 · N115

the diagnosis or documentation does not meet the LCD or billing article that lists A4640

CARC 151 · N362

units of A4640 exceed the DME supplier MUE of 1 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 A4640 claims

QuickAuth coordinates the requirement checks and documentation that DME claims for A4640 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 A4640

What does HCPCS code A4640 describe?

"Replacement pad for use with medically necessary alternating pressure pad owned by patient" (short descriptor "Alternating pressure pad"), in the A section (transportation, medical and surgical supplies, administrative, miscellaneous and investigational). Added 1991-01-01.

Is A4640 a CPT code?

No: CMS maintains A4640 in HCPCS Level II, while the AMA maintains CPT. It goes in the same procedure-code field.

What does Medicare pay for A4640?

A4640 is paid from the DMEPOS fee schedule as inexpensive and other routinely purchased items (IN): NU (purchased, new) $58.10 in CA, NV, OR and 1 more to $72.47 in CT, MA, ME and 3 more, rural $74.59 to $81.35; RR (rental) $5.81 in CA, NV, OR and 1 more to $7.25 in CT, MA, ME and 3 more, rural $7.53 to $8.22; UE (purchased, used) $43.58 in CA, NV, OR and 1 more to $54.35 in CT, MA, ME and 3 more, rural $54.35 to $59.15, October 2026.

How many units of A4640 can be billed per day?

MUE limits for A4640: practitioner 0 (MAI 3, CMS Policy); hospital outpatient 0 (MAI 3, CMS Policy); DME supplier 1 (MAI 2, Code Descriptor / CPT Instruction). 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 A4640?

Coverage code D (special coverage instructions apply). 1 active LCD lists A4640: L33830 (Pressure Reducing Support Surfaces - Group 1).

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.