A4636 HCPCS code: Replacement, handgrip, cane, crutch, or walker, each
A4636 is the HCPCS Level II code for replacement, handgrip, cane, crutch, or walker, each. The 2026 Medicare DMEPOS fee schedule pays $2.90 to $5.47 (NU, new equipment, purchased) 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 2 per day on DME suppliers. Medicare volume rose 17% from 2022 to 2024 (448 to 523 services). In 2024, 17 suppliers billed Medicare for A4636 (purchases), serving 287 beneficiaries. Its average fee ranks 4 of 13 A46 codes billed NU (family range $2.30–$66.87); rural fees run 13% higher.
Code details
| Field | Value |
|---|---|
| Section | A codes — Transportation, medical/surgical supplies and miscellaneous |
| Coverage code | D — Special coverage instructions apply |
| Pricing indicator | 32 — DMEPOS: inexpensive or routinely purchased item |
| BETOS category | D1E — Other durable medical equipment |
| Added | 1991-01-01 |
| Last action effective | 1996-01-01 |
2026 Medicare DMEPOS fee schedule for A4636
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| NU | new equipment, purchased | $2.90 | $5.47 | — | — |
| RR | rental (monthly) | $0.36 | $0.51 | — | — |
| UE | used equipment, purchased | $2.21 | $4.08 | — | — |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | NU | $5.24 | — |
| AL | NU | $3.97 | $4.62 |
| AR | NU | $3.97 | $4.51 |
| AZ | NU | $3.97 | $4.51 |
| CA | NU | $3.97 | $4.95 |
| CO | NU | $3.97 | $4.95 |
| CT | NU | $3.97 | $4.95 |
| DC | NU | $3.97 | $4.51 |
| DE | NU | $3.97 | $4.51 |
| FL | NU | $3.97 | $4.51 |
| GA | NU | $3.97 | $4.51 |
| HI | NU | $5.47 | — |
| IA | NU | $3.97 | $4.95 |
| ID | NU | $3.97 | $4.95 |
| IL | NU | $3.97 | $4.95 |
| IN | NU | $3.97 | $4.95 |
| KS | NU | $3.97 | $4.51 |
| KY | NU | $3.97 | $4.95 |
| LA | NU | $3.97 | $4.95 |
| MA | NU | $3.97 | $4.95 |
| MD | NU | $3.97 | $4.61 |
| ME | NU | $3.97 | $4.95 |
| MI | NU | $3.97 | $4.51 |
| MN | NU | $3.97 | $4.64 |
| MO | NU | $3.97 | $4.95 |
| MS | NU | $3.97 | $4.95 |
| MT | NU | $3.97 | $4.95 |
| NC | NU | $3.97 | $4.54 |
| ND | NU | $3.97 | $4.51 |
| NE | NU | $3.97 | $4.51 |
| NH | NU | $3.97 | $4.95 |
| NJ | NU | $3.97 | $4.51 |
| NM | NU | $3.97 | $4.51 |
| NV | NU | $3.97 | $4.51 |
| NY | NU | $3.97 | $4.95 |
| OH | NU | $3.97 | $4.51 |
| OK | NU | $3.97 | $4.95 |
| OR | NU | $3.97 | $4.95 |
| PA | NU | $3.97 | $4.51 |
| PR | NU | $3.32 | — |
| RI | NU | $3.97 | $4.95 |
| SC | NU | $3.97 | $4.51 |
| SD | NU | $3.97 | $4.51 |
| TN | NU | $3.97 | $4.51 |
| TX | NU | $3.97 | $4.51 |
| UT | NU | $3.97 | $4.95 |
| VA | NU | $3.97 | $4.95 |
| VI | NU | $4.95 | — |
| VT | NU | $3.97 | $4.95 |
| WA | NU | $3.97 | $4.95 |
| WI | NU | $3.97 | $4.95 |
| WV | NU | $3.97 | $4.51 |
| WY | NU | $3.97 | $4.95 |
| AK | RR | $0.48 | — |
| AL | RR | $0.40 | $0.46 |
| AR | RR | $0.40 | $0.46 |
| AZ | RR | $0.40 | $0.50 |
| CA | RR | $0.40 | $0.48 |
| CO | RR | $0.40 | $0.50 |
| CT | RR | $0.40 | $0.50 |
| DC | RR | $0.40 | $0.46 |
| DE | RR | $0.40 | $0.46 |
| FL | RR | $0.40 | $0.46 |
| GA | RR | $0.40 | $0.46 |
| HI | RR | $0.51 | — |
| IA | RR | $0.40 | $0.50 |
| ID | RR | $0.40 | $0.50 |
| IL | RR | $0.40 | $0.49 |
| IN | RR | $0.40 | $0.50 |
| KS | RR | $0.40 | $0.46 |
| KY | RR | $0.40 | $0.50 |
| LA | RR | $0.40 | $0.50 |
| MA | RR | $0.40 | $0.50 |
| MD | RR | $0.40 | $0.46 |
| ME | RR | $0.40 | $0.50 |
| MI | RR | $0.40 | $0.46 |
| MN | RR | $0.40 | $0.46 |
| MO | RR | $0.40 | $0.50 |
| MS | RR | $0.40 | $0.50 |
| MT | RR | $0.40 | $0.50 |
| NC | RR | $0.40 | $0.46 |
| ND | RR | $0.40 | $0.46 |
| NE | RR | $0.40 | $0.46 |
| NH | RR | $0.40 | $0.50 |
| NJ | RR | $0.40 | $0.50 |
| NM | RR | $0.40 | $0.46 |
| NV | RR | $0.40 | $0.50 |
| NY | RR | $0.40 | $0.49 |
| OH | RR | $0.40 | $0.46 |
| OK | RR | $0.40 | $0.50 |
| OR | RR | $0.40 | $0.50 |
| PA | RR | $0.40 | $0.46 |
| PR | RR | $0.41 | — |
| RI | RR | $0.40 | $0.50 |
| SC | RR | $0.40 | $0.46 |
| SD | RR | $0.40 | $0.46 |
| TN | RR | $0.40 | $0.46 |
| TX | RR | $0.40 | $0.46 |
| UT | RR | $0.40 | $0.50 |
| VA | RR | $0.40 | $0.50 |
| VI | RR | $0.49 | — |
| VT | RR | $0.40 | $0.50 |
| WA | RR | $0.40 | $0.50 |
| WI | RR | $0.40 | $0.50 |
| WV | RR | $0.40 | $0.46 |
| WY | RR | $0.40 | $0.50 |
| AK | UE | $3.93 | — |
| AL | UE | $2.98 | $3.60 |
| AR | UE | $2.98 | $3.33 |
| AZ | UE | $2.98 | $3.33 |
| CA | UE | $2.98 | $3.65 |
| CO | UE | $2.98 | $3.65 |
| CT | UE | $2.98 | $3.65 |
| DC | UE | $2.98 | $3.33 |
| DE | UE | $2.98 | $3.33 |
| FL | UE | $2.98 | $3.33 |
| GA | UE | $2.98 | $3.33 |
| HI | UE | $4.08 | — |
| IA | UE | $2.98 | $3.65 |
| ID | UE | $2.98 | $3.65 |
| IL | UE | $2.98 | $3.65 |
| IN | UE | $2.98 | $3.65 |
| KS | UE | $2.98 | $3.33 |
| KY | UE | $2.98 | $3.65 |
| LA | UE | $2.98 | $3.65 |
| MA | UE | $2.98 | $3.65 |
| MD | UE | $2.98 | $3.46 |
| ME | UE | $2.98 | $3.65 |
| MI | UE | $2.98 | $3.33 |
| MN | UE | $2.98 | $3.48 |
| MO | UE | $2.98 | $3.65 |
| MS | UE | $2.98 | $3.65 |
| MT | UE | $2.98 | $3.65 |
| NC | UE | $2.98 | $3.41 |
| ND | UE | $2.98 | $3.33 |
| NE | UE | $2.98 | $3.33 |
| NH | UE | $2.98 | $3.65 |
| NJ | UE | $2.98 | $3.33 |
| NM | UE | $2.98 | $3.33 |
| NV | UE | $2.98 | $3.33 |
| NY | UE | $2.98 | $3.65 |
| OH | UE | $2.98 | $3.33 |
| OK | UE | $2.98 | $3.65 |
| OR | UE | $2.98 | $3.65 |
| PA | UE | $2.98 | $3.33 |
| PR | UE | $2.53 | — |
| RI | UE | $2.98 | $3.65 |
| SC | UE | $2.98 | $3.33 |
| SD | UE | $2.98 | $3.33 |
| TN | UE | $2.98 | $3.33 |
| TX | UE | $2.98 | $3.33 |
| UT | UE | $2.98 | $3.65 |
| VA | UE | $2.98 | $3.65 |
| VI | UE | $3.65 | — |
| VT | UE | $2.98 | $3.65 |
| WA | UE | $2.98 | $3.65 |
| WI | UE | $2.98 | $3.65 |
| WV | UE | $2.98 | $3.33 |
| WY | UE | $2.98 | $3.65 |
How the A4636 fee compares
| Measure | Value |
|---|---|
| Rank among 13 A46 codes billed NU (lowest = 1) | 4 |
| Family fee range (average of state fees) | $2.30–$66.87 |
| Rural fee uplift | 12.8% |
Who bills A4636 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 17 |
| Referring clinicians | 186 |
| Medicare beneficiaries | 287 |
| States with claims | 2 |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 23 | 241 |
| 2023 | 24 | 208 |
| 2024 | 17 | 287 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for A4636, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 448 | 241 | $3.52 | $2.61 |
| 2023 | 381 | 208 | $3.78 | $2.84 |
| 2024 | 523 | 287 | $3.67 | $2.84 |
States with the most A4636 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Nevada | 310 | $2.80 |
| California | 179 | $2.92 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| DME suppliers | 2 | Code Descriptor / CPT Instruction |
Medicare policy articles for this code
- A52503: Walkers - Policy Article (CGS Administrators, LLC (DME MAC) Noridian Healthcare Solutions, LLC (DME MAC)) — mentions this code in its coding guidance
What changed for A4636
- 2026-01-01: Average state fee (NU) rose 2.7%: $3.94 to $4.05
- 2026-01-01: Average state fee (RR) rose 2.5%: $0.40 to $0.41
- 2026-01-01: Average state fee (UE) rose 2.6%: $2.96 to $3.04
- 1991-01-01: A4636 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 A4636?
A4636 is the HCPCS Level II code for replacement, handgrip, cane, crutch, or walker, each. Short descriptor: "Handgrip for cane etc".
How much does Medicare pay for A4636?
Under the 2026 DMEPOS fee schedule, non-rural state fees are NU (new equipment, purchased): $2.90–$5.47; RR (rental (monthly)): $0.36–$0.51; UE (used equipment, purchased): $2.21–$4.08. Rural fees can be higher.
Does Medicare cover A4636?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
Did the Medicare fee for A4636 change in 2026?
The average non-rural state fee for NU moved from $3.94 in 2025 to $4.05 in 2026 (+2.7%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of A4636 can be billed per day?
2 on DME suppliers (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 A4636
- Watch A4636 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for A4636
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.