A4481 HCPCS code: Tracheostoma filter, any type, any size, each
A4481 is the HCPCS Level II code for tracheostoma filter, any type, any size, each. The 2026 Medicare DMEPOS fee schedule pays $0.51 to $0.77 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 186 per day on DME suppliers. Medicare volume fell 14% from 2022 to 2024 (115,965 to 100,030 services). In 2024, 80 suppliers billed Medicare for A4481 (purchases), serving 449 beneficiaries; New York, Texas, Florida accounted for 29% of services. Its average fee ranks 3 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 | D — Special coverage instructions apply |
| Pricing indicator | 37 — DMEPOS: ostomy, tracheostomy and urological supplies |
| BETOS category | D1F — Prosthetic and orthotic devices |
| Added | 1997-01-01 |
| Last action effective | 2003-01-01 |
2026 Medicare DMEPOS fee schedule for A4481
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $0.51 | $0.77 | $0.52 | $0.44 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $0.68 | — |
| AL | — | $0.52 | — |
| AR | — | $0.52 | — |
| AZ | — | $0.52 | — |
| CA | — | $0.52 | — |
| CO | — | $0.52 | — |
| CT | — | $0.51 | — |
| DC | — | $0.51 | — |
| DE | — | $0.51 | — |
| FL | — | $0.51 | — |
| GA | — | $0.52 | — |
| HI | — | $0.77 | — |
| IA | — | $0.52 | — |
| ID | — | $0.52 | — |
| IL | — | $0.51 | — |
| IN | — | $0.52 | — |
| KS | — | $0.52 | — |
| KY | — | $0.52 | — |
| LA | — | $0.52 | — |
| MA | — | $0.51 | — |
| MD | — | $0.51 | — |
| ME | — | $0.51 | — |
| MI | — | $0.52 | — |
| MN | — | $0.52 | — |
| MO | — | $0.52 | — |
| MS | — | $0.52 | — |
| MT | — | $0.52 | — |
| NC | — | $0.52 | — |
| ND | — | $0.52 | — |
| NE | — | $0.52 | — |
| NH | — | $0.51 | — |
| NJ | — | $0.51 | — |
| NM | — | $0.52 | — |
| NV | — | $0.52 | — |
| NY | — | $0.51 | — |
| OH | — | $0.51 | — |
| OK | — | $0.52 | — |
| OR | — | $0.52 | — |
| PA | — | $0.51 | — |
| PR | — | $0.54 | — |
| RI | — | $0.51 | — |
| SC | — | $0.52 | — |
| SD | — | $0.52 | — |
| TN | — | $0.52 | — |
| TX | — | $0.51 | — |
| UT | — | $0.52 | — |
| VA | — | $0.51 | — |
| VI | — | $0.52 | — |
| VT | — | $0.51 | — |
| WA | — | $0.52 | — |
| WI | — | $0.52 | — |
| WV | — | $0.51 | — |
| WY | — | $0.52 | — |
How the A4481 fee compares
| Measure | Value |
|---|---|
| Rank among 42 A44 codes (lowest = 1) | 3 |
| Family fee range (average of state fees) | $0.15–$160.42 |
| Rural fee uplift | — |
Who bills A4481 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 80 |
| Referring clinicians | 418 |
| Medicare beneficiaries | 449 |
| States with claims | 29 |
| Share of services in top 3 states (New York, Texas, Florida) | 29% |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 79 | 532 |
| 2023 | 99 | 526 |
| 2024 | 80 | 449 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for A4481, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 115,965 | 532 | $0.44 | $0.31 |
| 2023 | 111,903 | 526 | $0.48 | $0.35 |
| 2024 | 100,030 | 449 | $0.49 | $0.36 |
States with the most A4481 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| New York | 10,365 | $0.37 |
| Texas | 8,533 | $0.35 |
| Florida | 7,915 | $0.35 |
| California | 7,716 | $0.36 |
| Pennsylvania | 4,190 | $0.38 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| DME suppliers | 186 | CMS Policy |
| outpatient hospital claims | 2 | Clinical: CMS Workgroup |
Medicare policy articles for this code
- A52492: Tracheostomy Care Supplies - Policy Article (CGS Administrators, LLC (DME MAC) Noridian Healthcare Solutions, LLC (DME MAC)) — mentions this code in its coding guidance
Covered diagnoses (10 ICD-10-CM codes)
The diagnoses most often listed as covered in the policy articles above:
| ICD-10-CM | Diagnosis | Articles listing it |
|---|---|---|
| J95.00 | Unspecified tracheostomy complication | 1 |
| J95.01 | Hemorrhage from tracheostomy stoma | 1 |
| J95.02 | Infection of tracheostomy stoma | 1 |
| J95.03 | Malfunction of tracheostomy stoma | 1 |
| J95.04 | Tracheo-esophageal fistula following tracheostomy | 1 |
| J95.09 | Other tracheostomy complication | 1 |
| Z43.0 | Encounter for attention to tracheostomy | 1 |
| Z90.02 | Acquired absence of larynx | 1 |
| Z93.0 | Tracheostomy status | 1 |
| Z96.3 | Presence of artificial larynx | 1 |
What changed for A4481
- 2026-01-01: Average state fee rose 2.0%: $0.51 to $0.52
- 1997-01-01: A4481 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 A4481?
A4481 is the HCPCS Level II code for tracheostoma filter, any type, any size, each. Short descriptor: "Tracheostoma filter".
How much does Medicare pay for A4481?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $0.51–$0.77. Rural fees can be higher.
Does Medicare cover A4481?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
Which diagnoses support coverage for A4481?
Medicare policy articles that cite A4481 list 10 covered ICD-10-CM diagnosis codes across 1 article. The most cited include J95.00 (Unspecified tracheostomy complication), J95.01 (Hemorrhage from tracheostomy stoma), J95.02 (Infection of tracheostomy stoma). A listed diagnosis is necessary but not sufficient; the policy's other criteria still apply.
Did the Medicare fee for A4481 change in 2026?
The average non-rural state fee moved from $0.51 in 2025 to $0.52 in 2026 (+2.0%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of A4481 can be billed per day?
186 on DME suppliers; 2 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)
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 A4481
- Watch A4481 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for A4481
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.