A4320 HCPCS code: Irrigation tray with bulb or piston syringe, any purpose
A4320 is the HCPCS Level II code for irrigation tray with bulb or piston syringe, any purpose. The 2026 Medicare DMEPOS fee schedule pays $6.34 to $8.42 depending on the state. Its Medicare coverage code is D (Special coverage instructions apply): Medicare covers it when its national or local coverage criteria are met. The NCCI unit limit is 2 per day on outpatient hospital claims. Medicare volume fell 67% from 2022 to 2024 (54,894 to 17,909 services). In 2024, 306 suppliers billed Medicare for A4320 (purchases), serving 2,161 beneficiaries; Wisconsin, Minnesota, New York accounted for 22% of services. Its average fee ranks 25 of 68 A43 codes (family range $0.05–$878.06).
Code details
| Field | Value |
|---|---|
| Section | A codes — Transportation, medical/surgical supplies and miscellaneous |
| Coverage code | D — Special coverage instructions apply |
| Pricing indicator | 37 — DMEPOS: ostomy, tracheostomy and urological supplies |
| BETOS category | D1A — Medical/surgical supplies |
| Added | 1990-01-01 |
| Last action effective | 1992-01-01 |
2026 Medicare DMEPOS fee schedule for A4320
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $6.34 | $8.42 | $7.61 | $6.47 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $6.34 | — |
| AL | — | $7.61 | — |
| AR | — | $7.61 | — |
| AZ | — | $7.49 | — |
| CA | — | $6.47 | — |
| CO | — | $7.52 | — |
| CT | — | $7.61 | — |
| DC | — | $7.16 | — |
| DE | — | $7.16 | — |
| FL | — | $7.61 | — |
| GA | — | $6.72 | — |
| HI | — | $6.79 | — |
| IA | — | $6.77 | — |
| ID | — | $7.61 | — |
| IL | — | $7.09 | — |
| IN | — | $7.44 | — |
| KS | — | $7.36 | — |
| KY | — | $7.61 | — |
| LA | — | $7.61 | — |
| MA | — | $7.61 | — |
| MD | — | $7.61 | — |
| ME | — | $7.61 | — |
| MI | — | $7.01 | — |
| MN | — | $7.61 | — |
| MO | — | $7.11 | — |
| MS | — | $6.47 | — |
| MT | — | $6.73 | — |
| NC | — | $6.47 | — |
| ND | — | $7.61 | — |
| NE | — | $7.36 | — |
| NH | — | $7.61 | — |
| NJ | — | $7.16 | — |
| NM | — | $7.61 | — |
| NV | — | $7.61 | — |
| NY | — | $6.96 | — |
| OH | — | $6.78 | — |
| OK | — | $7.61 | — |
| OR | — | $7.61 | — |
| PA | — | $7.16 | — |
| PR | — | $8.42 | — |
| RI | — | $7.61 | — |
| SC | — | $7.61 | — |
| SD | — | $7.61 | — |
| TN | — | $6.52 | — |
| TX | — | $6.47 | — |
| UT | — | $7.21 | — |
| VA | — | $7.61 | — |
| VI | — | $6.96 | — |
| VT | — | $7.61 | — |
| WA | — | $7.61 | — |
| WI | — | $7.61 | — |
| WV | — | $6.78 | — |
| WY | — | $7.61 | — |
How the A4320 fee compares
| Measure | Value |
|---|---|
| Rank among 68 A43 codes (lowest = 1) | 25 |
| Family fee range (average of state fees) | $0.05–$878.06 |
| Rural fee uplift | — |
Who bills A4320 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 306 |
| Referring clinicians | 1,626 |
| Medicare beneficiaries | 2,161 |
| States with claims | 47 |
| Share of services in top 3 states (Wisconsin, Minnesota, New York) | 22% |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 345 | 2,760 |
| 2023 | 303 | 2,556 |
| 2024 | 306 | 2,161 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for A4320, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 54,894 | 2,760 | $6.07 | $4.53 |
| 2023 | 39,677 | 2,556 | $6.61 | $4.84 |
| 2024 | 17,909 | 2,161 | $6.81 | $4.92 |
States with the most A4320 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Wisconsin | 1,461 | $5.12 |
| Minnesota | 1,290 | $5.46 |
| New York | 1,141 | $4.65 |
| Ohio | 1,114 | $4.95 |
| Pennsylvania | 1,058 | $4.82 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 2 | Clinical: Data |
What changed for A4320
- 2026-01-01: Average state fee rose 2.0%: $7.14 to $7.29
- 1990-01-01: A4320 added to HCPCS Level II
- Next scheduled CMS quarterly update (HCPCS and DMEPOS fee schedule): 2027-01-01
Frequently asked questions
What is HCPCS code A4320?
A4320 is the HCPCS Level II code for irrigation tray with bulb or piston syringe, any purpose. Short descriptor: "Irrigation tray".
How much does Medicare pay for A4320?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $6.34–$8.42. Rural fees can be higher.
Does Medicare cover A4320?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
Did the Medicare fee for A4320 change in 2026?
The average non-rural state fee moved from $7.14 in 2025 to $7.29 in 2026 (+2.0%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of A4320 can be billed per day?
2 on outpatient hospital claims (NCCI medically unlikely edits).
Related A43 codes
- A4300 — Implantable access catheter, (e.g., venous, arterial, epidural subarachnoid, or peritoneal, etc.) external access
- A4301 — Implantable access total catheter, port/reservoir (e.g., venous, arterial, epidural, subarachnoid, peritoneal, etc.)
- A4305 — Disposable drug delivery system, flow rate of 50 ml or greater per hour
- A4306 — Disposable drug delivery system, flow rate of less than 50 ml per hour
- A4310 — Insertion tray without drainage bag and without catheter (accessories only) ($9.36–$25.22)
- A4311 — Insertion tray without drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) ($16.05–$28.00)
- A4312 — Insertion tray without drainage bag with indwelling catheter, foley type, two-way, all silicone ($21.85–$36.59)
- A4313 — Insertion tray without drainage bag with indwelling catheter, foley type, three-way, for continuous irrigation ($22.44–$40.49)
- A4314 — Insertion tray with drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) ($30.63–$41.77)
- A4315 — Insertion tray with drainage bag with indwelling catheter, foley type, two-way, all silicone ($31.95–$48.37)
- A4316 — Insertion tray with drainage bag with indwelling catheter, foley type, three-way, for continuous irrigation ($34.40–$48.37)
- A4318 — Female external urinary collection cup, with or without ring attachment, per day
Building a device that would bill under a code like this? Caduvo matches a device description to HCPCS/CPT codes, Medicare coverage and payment, and the FDA pathway in one report.
Next steps
- Run a reimbursement report for a device billed under A4320
- Watch A4320 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for A4320
Sources: CMS HCPCS Level II release October 2026; CMS DMEPOS fee schedule 2026; CMS NCCI MUE tables; CMS Medicare utilization (physician and DME supplier files); CMS Medicare Coverage Database articles. Fees are Medicare allowables, not commercial rates. Not billing or legal advice.