A4626 HCPCS code: Tracheostomy cleaning brush, each
A4626 is the HCPCS Level II code for tracheostomy cleaning brush, each. The 2026 Medicare DMEPOS fee schedule pays $1.75 to $4.54 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 6 per day on DME suppliers. Medicare volume rose 243% from 2022 to 2024 (3,556 to 12,211 services). In 2024, 30 suppliers billed Medicare for A4626 (purchases), serving 1,076 beneficiaries; California, Texas, Pennsylvania accounted for 25% of services. Its average fee ranks 4 of 10 A46 codes (family range $0.08–$71.71).
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 | 1990-01-01 |
| Last action effective | 2003-01-01 |
2026 Medicare DMEPOS fee schedule for A4626
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $1.75 | $4.54 | $4.54 | $3.86 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $3.22 | — |
| AL | — | $4.19 | — |
| AR | — | $4.54 | — |
| AZ | — | $3.86 | — |
| CA | — | $3.86 | — |
| CO | — | $4.54 | — |
| CT | — | $4.54 | — |
| DC | — | $4.54 | — |
| DE | — | $4.54 | — |
| FL | — | $3.86 | — |
| GA | — | $4.54 | — |
| HI | — | $3.46 | — |
| IA | — | $4.54 | — |
| ID | — | $3.86 | — |
| IL | — | $3.86 | — |
| IN | — | $4.54 | — |
| KS | — | $3.86 | — |
| KY | — | $3.86 | — |
| LA | — | $4.54 | — |
| MA | — | $4.54 | — |
| MD | — | $4.54 | — |
| ME | — | $4.54 | — |
| MI | — | $3.86 | — |
| MN | — | $4.43 | — |
| MO | — | $3.86 | — |
| MS | — | $4.53 | — |
| MT | — | $4.54 | — |
| NC | — | $3.86 | — |
| ND | — | $3.86 | — |
| NE | — | $3.86 | — |
| NH | — | $4.54 | — |
| NJ | — | $4.54 | — |
| NM | — | $4.54 | — |
| NV | — | $3.98 | — |
| NY | — | $4.54 | — |
| OH | — | $4.54 | — |
| OK | — | $4.54 | — |
| OR | — | $3.86 | — |
| PA | — | $4.54 | — |
| PR | — | $1.75 | — |
| RI | — | $4.54 | — |
| SC | — | $3.86 | — |
| SD | — | $3.86 | — |
| TN | — | $3.86 | — |
| TX | — | $3.86 | — |
| UT | — | $4.54 | — |
| VA | — | $4.54 | — |
| VI | — | $4.54 | — |
| VT | — | $4.54 | — |
| WA | — | $4.54 | — |
| WI | — | $3.86 | — |
| WV | — | $4.54 | — |
| WY | — | $3.86 | — |
How the A4626 fee compares
| Measure | Value |
|---|---|
| Rank among 10 A46 codes (lowest = 1) | 4 |
| Family fee range (average of state fees) | $0.08–$71.71 |
| Rural fee uplift | — |
Who bills A4626 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 30 |
| Referring clinicians | 596 |
| Medicare beneficiaries | 1,076 |
| States with claims | 34 |
| Share of services in top 3 states (California, Texas, Pennsylvania) | 25% |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 40 | 440 |
| 2023 | 35 | 837 |
| 2024 | 30 | 1,076 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for A4626, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 3,556 | 440 | $3.59 | $2.71 |
| 2023 | 8,178 | 837 | $3.91 | $3.00 |
| 2024 | 12,211 | 1,076 | $4.01 | $3.08 |
States with the most A4626 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| California | 1,184 | $2.85 |
| Texas | 906 | $2.95 |
| Pennsylvania | 840 | $3.36 |
| Florida | 741 | $2.95 |
| New York | 726 | $3.40 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| DME suppliers | 6 | Published Contractor Policy |
| outpatient hospital claims | 1 | Nature of Equipment |
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 A4626
- 2026-01-01: Average state fee rose 2.1%: $4.09 to $4.18
- 1990-01-01: A4626 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 A4626?
A4626 is the HCPCS Level II code for tracheostomy cleaning brush, each. Short descriptor: "Tracheostomy cleaning brush".
How much does Medicare pay for A4626?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $1.75–$4.54. Rural fees can be higher.
Does Medicare cover A4626?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
Which diagnoses support coverage for A4626?
Medicare policy articles that cite A4626 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 A4626 change in 2026?
The average non-rural state fee moved from $4.09 in 2025 to $4.18 in 2026 (+2.1%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of A4626 can be billed per day?
6 on DME suppliers; 1 on outpatient hospital claims (NCCI medically unlikely edits).
Related A46 codes
- A4600 — Sleeve for intermittent limb compression device, replacement only, each
- A4601 — Lithium ion battery, rechargeable, for non-prosthetic use, replacement
- A4602 — Replacement battery for external infusion pump owned by patient, lithium, 1.5 volt, each ($5.31–$6.33)
- A4604 — Tubing with integrated heating element for use with positive airway pressure device ($49.31–$76.79)
- A4605 — Tracheal suction catheter, closed system, each ($23.31–$27.99)
- A4606 — Oxygen probe for use with oximeter device, replacement
- A4608 — Transtracheal oxygen catheter, each ($71.44–$85.73)
- A4611 — Battery, heavy duty; replacement for patient owned ventilator
- A4612 — Battery cables; replacement for patient-owned ventilator
- A4613 — Battery charger; replacement for patient-owned ventilator
- A4614 — Peak expiratory flow rate meter, hand held ($33.89–$40.68)
- A4615 — Cannula, nasal ($1.04–$1.25)
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 A4626
- Watch A4626 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for A4626
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.