A4542 HCPCS code: Supplies and accessories for external upper limb tremor stimulator of the peripheral nerves of the wrist
A4542 is the HCPCS Level II code for supplies and accessories for external upper limb tremor stimulator of the peripheral nerves of the wrist. The 2026 Medicare DMEPOS fee schedule pays $526.85 depending on the state. Its Medicare coverage code is C (Carrier judgment): Coverage is decided by the Medicare contractor (MAC) case by case. In 2024, 1 suppliers billed Medicare for A4542 (purchases), serving 674 beneficiaries; California, Washington, Florida accounted for 28% of services. Its average fee ranks 13 of 14 A45 codes (family range $0.13–$1,672.60).
Code details
| Field | Value |
|---|---|
| Section | A codes — Transportation, medical/surgical supplies and miscellaneous |
| Coverage code | C — Carrier judgment |
| Pricing indicator | 34 — DMEPOS: supplies necessary for the effective use of DME |
| BETOS category | D1E — Other durable medical equipment |
| Added | 2024-01-01 |
| Last action effective | 2024-01-01 |
2026 Medicare DMEPOS fee schedule for A4542
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $526.85 | $526.85 | $526.85 | $447.82 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $526.85 | — |
| AL | — | $526.85 | — |
| AR | — | $526.85 | — |
| AZ | — | $526.85 | — |
| CA | — | $526.85 | — |
| CO | — | $526.85 | — |
| CT | — | $526.85 | — |
| DC | — | $526.85 | — |
| DE | — | $526.85 | — |
| FL | — | $526.85 | — |
| GA | — | $526.85 | — |
| HI | — | $526.85 | — |
| IA | — | $526.85 | — |
| ID | — | $526.85 | — |
| IL | — | $526.85 | — |
| IN | — | $526.85 | — |
| KS | — | $526.85 | — |
| KY | — | $526.85 | — |
| LA | — | $526.85 | — |
| MA | — | $526.85 | — |
| MD | — | $526.85 | — |
| ME | — | $526.85 | — |
| MI | — | $526.85 | — |
| MN | — | $526.85 | — |
| MO | — | $526.85 | — |
| MS | — | $526.85 | — |
| MT | — | $526.85 | — |
| NC | — | $526.85 | — |
| ND | — | $526.85 | — |
| NE | — | $526.85 | — |
| NH | — | $526.85 | — |
| NJ | — | $526.85 | — |
| NM | — | $526.85 | — |
| NV | — | $526.85 | — |
| NY | — | $526.85 | — |
| OH | — | $526.85 | — |
| OK | — | $526.85 | — |
| OR | — | $526.85 | — |
| PA | — | $526.85 | — |
| PR | — | $526.85 | — |
| RI | — | $526.85 | — |
| SC | — | $526.85 | — |
| SD | — | $526.85 | — |
| TN | — | $526.85 | — |
| TX | — | $526.85 | — |
| UT | — | $526.85 | — |
| VA | — | $526.85 | — |
| VI | — | $526.85 | — |
| VT | — | $526.85 | — |
| WA | — | $526.85 | — |
| WI | — | $526.85 | — |
| WV | — | $526.85 | — |
| WY | — | $526.85 | — |
How the A4542 fee compares
| Measure | Value |
|---|---|
| Rank among 14 A45 codes (lowest = 1) | 13 |
| Family fee range (average of state fees) | $0.13–$1,672.60 |
| Rural fee uplift | — |
Who bills A4542 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 1 |
| Referring clinicians | 418 |
| Medicare beneficiaries | 674 |
| States with claims | 26 |
| Share of services in top 3 states (California, Washington, Florida) | 28% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for A4542, 2024–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2024 | 833 | 674 | $504.41 | $394.84 |
States with the most A4542 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| California | 75 | $395.46 |
| Washington | 75 | $395.46 |
| Florida | 55 | $395.46 |
| Illinois | 43 | $395.46 |
| Texas | 39 | $395.46 |
Medicare policy articles for this code
- A59680: External Upper Limb Tremor Stimulator Therapy - Policy Article (CGS Administrators, LLC (DME MAC) Noridian Healthcare Solutions, LLC (DME MAC)) — mentions this code in its coding guidance
Covered diagnoses (1 ICD-10-CM codes)
The diagnoses most often listed as covered in the policy articles above:
| ICD-10-CM | Diagnosis | Articles listing it |
|---|---|---|
| G25.0 | Essential tremor | 1 |
What changed for A4542
- 2026-01-01: Average state fee rose 2.0%: $516.52 to $526.85
- 2024-01-01: A4542 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 A4542?
A4542 is the HCPCS Level II code for supplies and accessories for external upper limb tremor stimulator of the peripheral nerves of the wrist. Short descriptor: "Supp ext up limb tremor stim".
How much does Medicare pay for A4542?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $526.85. Rural fees can be higher.
Does Medicare cover A4542?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Which diagnoses support coverage for A4542?
Medicare policy articles that cite A4542 list 1 covered ICD-10-CM diagnosis codes across 1 article. The most cited include G25.0 (Essential tremor). A listed diagnosis is necessary but not sufficient; the policy's other criteria still apply.
Did the Medicare fee for A4542 change in 2026?
The average non-rural state fee moved from $516.52 in 2025 to $526.85 in 2026 (+2.0%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
Related A45 codes
- A4500 — Surgical stockings below knee length, each
- A4510 — Surgical stockings full length, each
- A4520 — Incontinence garment, any type, (e.g., brief, diaper), each
- A4540 — Distal transcutaneous electrical nerve stimulator, stimulates peripheral nerves of the upper arm
- A4541 — Monthly supplies for use of device coded at e0733 ($40.40–$49.25)
- A4543 — Supplies for transcutaneous electrical nerve stimulator, for nerves in the auricular region, per month
- A4544 — Electrode for external lower extremity nerve stimulator for restless legs syndrome ($6.34–$6.34)
- A4545 — Supplies and accessories for external tibial nerve stimulator (e.g., socks, gel pads, electrodes, etc.), needed for one month ($38.21–$55.51)
- A4550 — Surgical trays
- A4553 — Non-disposable underpads, all sizes
- A4554 — Disposable underpads, all sizes
- A4555 — Electrode/transducer for use with electrical stimulation device used for cancer treatment, replacement only
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 A4542
- Watch A4542 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for A4542
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.