A4561 HCPCS code: Pessary, reusable, rubber, any type
A4561 is the HCPCS Level II code for pessary, reusable, rubber, any type. The 2026 Medicare DMEPOS fee schedule pays $28.43 to $29.45 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 outpatient hospital claims. Medicare volume fell 2% from 2022 to 2024 (6,667 to 6,523 services). In 2024, about 2,389 clinicians billed Medicare for A4561 for 5,440 beneficiaries; California, Ohio, Florida accounted for 26% of services. Its average fee ranks 8 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 | 38 — DMEPOS: orthotics, prosthetics, prosthetic devices and vision services |
| BETOS category | D1F — Prosthetic and orthotic devices |
| Added | 2001-01-01 |
| Last action effective | 2024-04-01 |
2026 Medicare DMEPOS fee schedule for A4561
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $28.43 | $29.45 | $34.73 | $26.05 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AL | — | $29.34 | — |
| AR | — | $29.33 | — |
| AZ | — | $28.43 | — |
| CA | — | $28.43 | — |
| CO | — | $29.45 | — |
| CT | — | $28.43 | — |
| DC | — | $28.43 | — |
| DE | — | $28.43 | — |
| FL | — | $29.34 | — |
| GA | — | $29.34 | — |
| IA | — | $29.02 | — |
| ID | — | $28.43 | — |
| IL | — | $29.21 | — |
| IN | — | $29.21 | — |
| KS | — | $29.02 | — |
| KY | — | $29.34 | — |
| LA | — | $29.33 | — |
| MA | — | $28.43 | — |
| MD | — | $28.43 | — |
| ME | — | $28.43 | — |
| MI | — | $29.21 | — |
| MN | — | $29.21 | — |
| MO | — | $29.02 | — |
| MS | — | $29.34 | — |
| MT | — | $29.45 | — |
| NC | — | $29.34 | — |
| ND | — | $29.45 | — |
| NE | — | $29.02 | — |
| NH | — | $28.43 | — |
| NJ | — | $28.43 | — |
| NM | — | $29.33 | — |
| NV | — | $28.43 | — |
| NY | — | $28.43 | — |
| OH | — | $29.21 | — |
| OK | — | $29.33 | — |
| OR | — | $28.43 | — |
| PA | — | $28.43 | — |
| RI | — | $28.43 | — |
| SC | — | $29.34 | — |
| SD | — | $29.45 | — |
| TN | — | $29.34 | — |
| TX | — | $29.33 | — |
| UT | — | $29.45 | — |
| VA | — | $28.43 | — |
| VT | — | $28.43 | — |
| WA | — | $28.43 | — |
| WI | — | $29.21 | — |
| WV | — | $28.43 | — |
| WY | — | $29.45 | — |
How the A4561 fee compares
| Measure | Value |
|---|---|
| Rank among 14 A45 codes (lowest = 1) | 8 |
| Family fee range (average of state fees) | $0.13–$1,672.60 |
| Rural fee uplift | — |
Who bills A4561 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 2,389 |
| Medicare beneficiaries | 5,440 |
| States with claims | 44 |
| Share of services in top 3 states (California, Ohio, Florida) | 26% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for A4561, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 6,667 | 5,655 | $24.42 | $17.80 |
| 2023 | 6,646 | 5,617 | $26.29 | $19.22 |
| 2024 | 6,523 | 5,440 | $26.99 | $19.70 |
States with the most A4561 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| California | 897 | $20.00 |
| Ohio | 413 | $19.97 |
| Florida | 403 | $19.96 |
| Texas | 358 | $19.90 |
| Pennsylvania | 339 | $18.78 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 1 | Nature of Equipment |
| practitioner claims | 1 | Nature of Equipment |
What changed for A4561
- 2026-01-01: Average state fee rose 2.0%: $28.37 to $28.94
- 2001-01-01: A4561 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 A4561?
A4561 is the HCPCS Level II code for pessary, reusable, rubber, any type. Short descriptor: "Pessary reusable rub anytype".
How much does Medicare pay for A4561?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $28.43–$29.45. Rural fees can be higher.
Does Medicare cover A4561?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Did the Medicare fee for A4561 change in 2026?
The average non-rural state fee moved from $28.37 in 2025 to $28.94 in 2026 (+2.0%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of A4561 can be billed per day?
1 on outpatient hospital claims; 1 on practitioner claims (NCCI medically unlikely edits).
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)
- A4542 — Supplies and accessories for external upper limb tremor stimulator of the peripheral nerves of the wrist ($526.85–$526.85)
- 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
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 A4561
- Watch A4561 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for A4561
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.