A4628 HCPCS code: Oral and/or oropharyngeal suction catheter, each
A4628 is the HCPCS Level II code for oral and/or oropharyngeal suction catheter, each. The 2026 Medicare DMEPOS fee schedule pays $5.20 to $6.27 (NU, new equipment, purchased) 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 36 per day on DME suppliers. Its average fee ranks 5 of 13 A46 codes billed NU (family range $2.30–$66.87).
Code details
| Field | Value |
|---|---|
| Section | A codes — Transportation, medical/surgical supplies and miscellaneous |
| Coverage code | C — Carrier judgment |
| Pricing indicator | 32 — DMEPOS: inexpensive or routinely purchased item |
| BETOS category | D1E — Other durable medical equipment |
| Added | 1996-01-01 |
| Last action effective | 2023-04-01 |
2026 Medicare DMEPOS fee schedule for A4628
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| NU | new equipment, purchased | $5.20 | $6.27 | $5.33 | $4.53 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | NU | $5.20 | — |
| AL | NU | $5.33 | — |
| AR | NU | $5.33 | — |
| AZ | NU | $5.20 | — |
| CA | NU | $5.20 | — |
| CO | NU | $5.33 | — |
| CT | NU | $5.33 | — |
| DC | NU | $5.33 | — |
| DE | NU | $5.22 | — |
| FL | NU | $5.22 | — |
| GA | NU | $5.33 | — |
| HI | NU | $5.20 | — |
| IA | NU | $5.20 | — |
| ID | NU | $5.20 | — |
| IL | NU | $5.33 | — |
| IN | NU | $5.33 | — |
| KS | NU | $5.20 | — |
| KY | NU | $5.33 | — |
| LA | NU | $5.33 | — |
| MA | NU | $5.33 | — |
| MD | NU | $5.33 | — |
| ME | NU | $5.33 | — |
| MI | NU | $5.33 | — |
| MN | NU | $5.33 | — |
| MO | NU | $5.20 | — |
| MS | NU | $5.33 | — |
| MT | NU | $5.20 | — |
| NC | NU | $5.33 | — |
| ND | NU | $5.20 | — |
| NE | NU | $5.20 | — |
| NH | NU | $5.22 | — |
| NJ | NU | $5.22 | — |
| NM | NU | $5.33 | — |
| NV | NU | $5.20 | — |
| NY | NU | $5.22 | — |
| OH | NU | $5.33 | — |
| OK | NU | $5.33 | — |
| OR | NU | $5.20 | — |
| PA | NU | $5.22 | — |
| PR | NU | $6.27 | — |
| RI | NU | $5.22 | — |
| SC | NU | $5.33 | — |
| SD | NU | $5.20 | — |
| TN | NU | $5.33 | — |
| TX | NU | $5.22 | — |
| UT | NU | $5.20 | — |
| VA | NU | $5.33 | — |
| VI | NU | $5.22 | — |
| VT | NU | $5.33 | — |
| WA | NU | $5.20 | — |
| WI | NU | $5.33 | — |
| WV | NU | $5.33 | — |
| WY | NU | $5.20 | — |
How the A4628 fee compares
| Measure | Value |
|---|---|
| Rank among 13 A46 codes billed NU (lowest = 1) | 5 |
| Family fee range (average of state fees) | $2.30–$66.87 |
| Rural fee uplift | — |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| DME suppliers | 36 | CMS Policy |
| outpatient hospital claims | 1 | Clinical: Data |
What changed for A4628
- 2026-01-01: Average state fee (NU) rose 1.9%: $5.19 to $5.29
- 1996-01-01: A4628 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 A4628?
A4628 is the HCPCS Level II code for oral and/or oropharyngeal suction catheter, each. Short descriptor: "Oropharyngeal suction cath".
How much does Medicare pay for A4628?
Under the 2026 DMEPOS fee schedule, non-rural state fees are NU (new equipment, purchased): $5.20–$6.27. Rural fees can be higher.
Does Medicare cover A4628?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Did the Medicare fee for A4628 change in 2026?
The average non-rural state fee for NU moved from $5.19 in 2025 to $5.29 in 2026 (+1.9%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of A4628 can be billed per day?
36 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)
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Next steps
- Run a reimbursement report for a device billed under A4628
- Watch A4628 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for A4628
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.