A4459 HCPCS code: Manual transanal irrigation system, includes water reservoir, pump, tubing, and accessories, without catheter, any type
A4459 is the HCPCS Level II code for manual transanal irrigation system, includes water reservoir, pump, tubing, and accessories, without catheter, any type. The 2026 Medicare DMEPOS fee schedule pays $160.42 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 1 per day on DME suppliers. Its average fee ranks 42 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 | 2015-01-01 |
| Last action effective | 2025-10-01 |
2026 Medicare DMEPOS fee schedule for A4459
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $160.42 | $160.42 | $192.50 | $144.38 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $160.42 | — |
| AL | — | $160.42 | — |
| AR | — | $160.42 | — |
| AZ | — | $160.42 | — |
| CA | — | $160.42 | — |
| CO | — | $160.42 | — |
| CT | — | $160.42 | — |
| DC | — | $160.42 | — |
| DE | — | $160.42 | — |
| FL | — | $160.42 | — |
| GA | — | $160.42 | — |
| HI | — | $160.42 | — |
| IA | — | $160.42 | — |
| ID | — | $160.42 | — |
| IL | — | $160.42 | — |
| IN | — | $160.42 | — |
| KS | — | $160.42 | — |
| KY | — | $160.42 | — |
| LA | — | $160.42 | — |
| MA | — | $160.42 | — |
| MD | — | $160.42 | — |
| ME | — | $160.42 | — |
| MI | — | $160.42 | — |
| MN | — | $160.42 | — |
| MO | — | $160.42 | — |
| MS | — | $160.42 | — |
| MT | — | $160.42 | — |
| NC | — | $160.42 | — |
| ND | — | $160.42 | — |
| NE | — | $160.42 | — |
| NH | — | $160.42 | — |
| NJ | — | $160.42 | — |
| NM | — | $160.42 | — |
| NV | — | $160.42 | — |
| NY | — | $160.42 | — |
| OH | — | $160.42 | — |
| OK | — | $160.42 | — |
| OR | — | $160.42 | — |
| PA | — | $160.42 | — |
| PR | — | $160.42 | — |
| RI | — | $160.42 | — |
| SC | — | $160.42 | — |
| SD | — | $160.42 | — |
| TN | — | $160.42 | — |
| TX | — | $160.42 | — |
| UT | — | $160.42 | — |
| VA | — | $160.42 | — |
| VI | — | $160.42 | — |
| VT | — | $160.42 | — |
| WA | — | $160.42 | — |
| WI | — | $160.42 | — |
| WV | — | $160.42 | — |
| WY | — | $160.42 | — |
How the A4459 fee compares
| Measure | Value |
|---|---|
| Rank among 42 A44 codes (lowest = 1) | 42 |
| 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 | 1 | Nature of Equipment |
| outpatient hospital claims | 1 | Nature of Equipment |
Medicare policy articles for this code
- A54516: Bowel Management Devices - Policy Article (CGS Administrators, LLC (DME MAC) Noridian Healthcare Solutions, LLC (DME MAC)) — mentions this code in its coding guidance
What changed for A4459
- April 2025: Descriptor revised (Was: Manual pump-operated enema system, includes balloon, catheter and all accessories, reusable, any type)
- 2025-10-01: Last CMS action: payment change (pricing indicator or payment group)
- 2015-01-01: A4459 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 A4459?
A4459 is the HCPCS Level II code for manual transanal irrigation system, includes water reservoir, pump, tubing, and accessories, without catheter, any type. Short descriptor: "Transanal irrigation, any".
How much does Medicare pay for A4459?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $160.42. Rural fees can be higher.
Does Medicare cover A4459?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
How many units of A4459 can be billed per day?
1 on DME suppliers; 1 on outpatient hospital claims (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 A4459
- Watch A4459 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for A4459
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.