A4563 HCPCS code: Rectal control system for vaginal insertion, for long term use, includes pump and all supplies and accessories, any type each
A4563 is the HCPCS Level II code for rectal control system for vaginal insertion, for long term use, includes pump and all supplies and accessories, any type each. The 2026 Medicare DMEPOS fee schedule pays $1,640.30 to $1,804.32 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. In 2024, about 10 clinicians billed Medicare for A4563 for 15 beneficiaries. Its average fee ranks 14 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 | 2019-01-01 |
| Last action effective | 2019-01-01 |
2026 Medicare DMEPOS fee schedule for A4563
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $1,640.30 | $1,804.32 | $2,002.25 | $1,501.69 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $1,640.30 | — |
| AL | — | $1,689.73 | — |
| AR | — | $1,689.55 | — |
| AZ | — | $1,640.30 | — |
| CA | — | $1,640.30 | — |
| CO | — | $1,702.37 | — |
| CT | — | $1,640.30 | — |
| DC | — | $1,640.30 | — |
| DE | — | $1,640.30 | — |
| FL | — | $1,689.73 | — |
| GA | — | $1,689.73 | — |
| HI | — | $1,640.30 | — |
| IA | — | $1,672.32 | — |
| ID | — | $1,640.30 | — |
| IL | — | $1,680.58 | — |
| IN | — | $1,680.58 | — |
| KS | — | $1,672.32 | — |
| KY | — | $1,689.73 | — |
| LA | — | $1,689.55 | — |
| MA | — | $1,640.30 | — |
| MD | — | $1,640.30 | — |
| ME | — | $1,640.30 | — |
| MI | — | $1,680.58 | — |
| MN | — | $1,680.58 | — |
| MO | — | $1,672.32 | — |
| MS | — | $1,689.73 | — |
| MT | — | $1,702.37 | — |
| NC | — | $1,689.73 | — |
| ND | — | $1,702.37 | — |
| NE | — | $1,672.32 | — |
| NH | — | $1,640.30 | — |
| NJ | — | $1,640.30 | — |
| NM | — | $1,689.55 | — |
| NV | — | $1,640.30 | — |
| NY | — | $1,640.30 | — |
| OH | — | $1,680.58 | — |
| OK | — | $1,689.55 | — |
| OR | — | $1,640.30 | — |
| PA | — | $1,640.30 | — |
| PR | — | $1,804.32 | — |
| RI | — | $1,640.30 | — |
| SC | — | $1,689.73 | — |
| SD | — | $1,702.37 | — |
| TN | — | $1,689.73 | — |
| TX | — | $1,689.55 | — |
| UT | — | $1,702.37 | — |
| VA | — | $1,640.30 | — |
| VI | — | $1,804.32 | — |
| VT | — | $1,640.30 | — |
| WA | — | $1,640.30 | — |
| WI | — | $1,680.58 | — |
| WV | — | $1,640.30 | — |
| WY | — | $1,702.37 | — |
How the A4563 fee compares
| Measure | Value |
|---|---|
| Rank among 14 A45 codes (lowest = 1) | 14 |
| Family fee range (average of state fees) | $0.13–$1,672.60 |
| Rural fee uplift | — |
Who bills A4563 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 10 |
| Medicare beneficiaries | 15 |
| States with claims | 0 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for A4563, 2023–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2023 | 17 | 15 | $1,304.79 | $1,039.59 |
| 2024 | 17 | 15 | $1,501.60 | $1,179.43 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 1 | Code Descriptor / CPT Instruction |
| practitioner claims | 1 | Code Descriptor / CPT Instruction |
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 A4563
- 2026-01-01: Average state fee rose 2.0%: $1,639.81 to $1,672.60
- 2019-01-01: A4563 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 A4563?
A4563 is the HCPCS Level II code for rectal control system for vaginal insertion, for long term use, includes pump and all supplies and accessories, any type each. Short descriptor: "Vag inser rectal control sys".
How much does Medicare pay for A4563?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $1,640.30–$1,804.32. Rural fees can be higher.
Does Medicare cover A4563?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Did the Medicare fee for A4563 change in 2026?
The average non-rural state fee moved from $1,639.81 in 2025 to $1,672.60 in 2026 (+2.0%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of A4563 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 A4563
- Watch A4563 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for A4563
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.