A4438 HCPCS code: Adhesive clip applied to the skin to secure external electrical nerve stimulator controller, each
A4438 is the HCPCS Level II code for adhesive clip applied to the skin to secure external electrical nerve stimulator controller, each. The 2026 Medicare DMEPOS fee schedule pays $1.62 to $2.62 depending on the state. Its Medicare coverage code is C (Carrier judgment): Coverage is decided by the Medicare contractor (MAC) case by case. The NCCI unit limit is 30 per day on DME suppliers. Its average fee ranks 5 of 42 A44 codes (family range $0.15–$160.42).
Code details
| Field | Value |
|---|---|
| Section | A codes — Transportation, medical/surgical supplies and miscellaneous |
| Coverage code | C — Carrier judgment |
| Pricing indicator | 38 — DMEPOS: orthotics, prosthetics, prosthetic devices and vision services |
| BETOS category | D1F — Prosthetic and orthotic devices |
| Added | 2024-04-01 |
| Last action effective | 2024-04-01 |
2026 Medicare DMEPOS fee schedule for A4438
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $1.62 | $2.62 | $2.62 | $1.96 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $1.62 | — |
| AL | — | $1.96 | — |
| AR | — | $2.62 | — |
| AZ | — | $1.96 | — |
| CA | — | $1.96 | — |
| CO | — | $2.62 | — |
| CT | — | $2.62 | — |
| DC | — | $2.01 | — |
| DE | — | $2.01 | — |
| FL | — | $1.96 | — |
| GA | — | $1.96 | — |
| HI | — | $1.69 | — |
| IA | — | $1.96 | — |
| ID | — | $1.96 | — |
| IL | — | $1.96 | — |
| IN | — | $1.96 | — |
| KS | — | $1.96 | — |
| KY | — | $1.96 | — |
| LA | — | $2.62 | — |
| MA | — | $2.62 | — |
| MD | — | $2.01 | — |
| ME | — | $2.62 | — |
| MI | — | $1.96 | — |
| MN | — | $1.96 | — |
| MO | — | $1.96 | — |
| MS | — | $1.96 | — |
| MT | — | $2.62 | — |
| NC | — | $1.96 | — |
| ND | — | $2.62 | — |
| NE | — | $1.96 | — |
| NH | — | $2.62 | — |
| NJ | — | $1.96 | — |
| NM | — | $2.62 | — |
| NV | — | $1.96 | — |
| NY | — | $1.96 | — |
| OH | — | $1.96 | — |
| OK | — | $2.62 | — |
| OR | — | $1.96 | — |
| PA | — | $2.01 | — |
| PR | — | $2.60 | — |
| RI | — | $2.62 | — |
| SC | — | $1.96 | — |
| SD | — | $2.62 | — |
| TN | — | $1.96 | — |
| TX | — | $2.62 | — |
| UT | — | $2.62 | — |
| VA | — | $2.01 | — |
| VI | — | $1.96 | — |
| VT | — | $2.62 | — |
| WA | — | $1.96 | — |
| WI | — | $1.96 | — |
| WV | — | $2.01 | — |
| WY | — | $2.62 | — |
How the A4438 fee compares
| Measure | Value |
|---|---|
| Rank among 42 A44 codes (lowest = 1) | 5 |
| Family fee range (average of state fees) | $0.15–$160.42 |
| Rural fee uplift | — |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| DME suppliers | 30 | Nature of Equipment |
What changed for A4438
- 2026-01-01: Average state fee rose 1.8%: $2.14 to $2.18
- 2024-04-01: A4438 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 A4438?
A4438 is the HCPCS Level II code for adhesive clip applied to the skin to secure external electrical nerve stimulator controller, each. Short descriptor: "Adhesive clip ext ens contr".
How much does Medicare pay for A4438?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $1.62–$2.62. Rural fees can be higher.
Does Medicare cover A4438?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Did the Medicare fee for A4438 change in 2026?
The average non-rural state fee moved from $2.14 in 2025 to $2.18 in 2026 (+1.8%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of A4438 can be billed per day?
30 on DME suppliers (NCCI medically unlikely edits).
Related A44 codes
- A4400 — Ostomy irrigation set ($59.20–$90.97)
- A4402 — Lubricant, per ounce ($1.93–$5.70)
- A4404 — Ostomy ring, each ($2.03–$2.60)
- A4405 — Ostomy skin barrier, non-pectin based, paste, per ounce ($4.87–$5.76)
- A4406 — Ostomy skin barrier, pectin-based, paste, per ounce ($8.16–$9.78)
- A4407 — Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, 4 x 4 inches or smaller, each ($12.48–$14.94)
- A4408 — Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, with built-in convexity, larger than 4 x 4 inches, each ($14.07–$16.87)
- A4409 — Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each ($8.84–$10.60)
- A4410 — Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, larger than 4 x 4 inches, each ($12.88–$15.43)
- A4411 — Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, with built-in convexity, each ($7.26–$8.70)
- A4412 — Ostomy pouch, drainable, high output, for use on a barrier with flange (2 piece system), without filter, each ($3.86–$4.56)
- A4413 — Ostomy pouch, drainable, high output, for use on a barrier with flange (2 piece system), with filter, each ($7.85–$9.44)
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Next steps
- Run a reimbursement report for a device billed under A4438
- Watch A4438 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for A4438
Sources: CMS HCPCS Level II release October 2025; 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.