A4637 HCPCS code: Replacement, tip, cane, crutch, walker, each.
A4637 is the HCPCS Level II code for replacement, tip, cane, crutch, walker, each.. The 2026 Medicare DMEPOS fee schedule pays $2.20 to $3.48 (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 4 per day on DME suppliers. Medicare volume rose 3% from 2022 to 2024 (403 to 416 services). In 2024, 25 suppliers billed Medicare for A4637 (purchases), serving 193 beneficiaries. Its average fee ranks 1 of 13 A46 codes billed NU (family range $2.30–$66.87); rural fees run 6% 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 A4637
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| NU | new equipment, purchased | $2.20 | $3.48 | — | — |
| RR | rental (monthly) | $0.22 | $0.37 | — | — |
| UE | used equipment, purchased | $1.66 | $2.60 | — | — |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | NU | $3.30 | — |
| AL | NU | $2.20 | $2.38 |
| AR | NU | $2.20 | $2.61 |
| AZ | NU | $2.20 | $2.38 |
| CA | NU | $2.20 | $2.61 |
| CO | NU | $2.20 | $2.61 |
| CT | NU | $2.20 | $2.61 |
| DC | NU | $2.20 | $2.55 |
| DE | NU | $2.20 | $2.49 |
| FL | NU | $2.20 | $2.38 |
| GA | NU | $2.20 | $2.38 |
| HI | NU | $3.48 | — |
| IA | NU | $2.20 | $2.61 |
| ID | NU | $2.20 | $2.38 |
| IL | NU | $2.20 | $2.61 |
| IN | NU | $2.20 | $2.55 |
| KS | NU | $2.20 | $2.61 |
| KY | NU | $2.20 | $2.61 |
| LA | NU | $2.20 | $2.61 |
| MA | NU | $2.20 | $2.61 |
| MD | NU | $2.20 | $2.61 |
| ME | NU | $2.20 | $2.61 |
| MI | NU | $2.20 | $2.38 |
| MN | NU | $2.20 | $2.38 |
| MO | NU | $2.20 | $2.61 |
| MS | NU | $2.20 | $2.61 |
| MT | NU | $2.20 | $2.38 |
| NC | NU | $2.20 | $2.61 |
| ND | NU | $2.20 | $2.61 |
| NE | NU | $2.20 | $2.61 |
| NH | NU | $2.20 | $2.49 |
| NJ | NU | $2.20 | $2.61 |
| NM | NU | $2.20 | $2.38 |
| NV | NU | $2.20 | $2.38 |
| NY | NU | $2.20 | $2.38 |
| OH | NU | $2.20 | $2.61 |
| OK | NU | $2.20 | $2.38 |
| OR | NU | $2.20 | $2.61 |
| PA | NU | $2.20 | $2.61 |
| PR | NU | $3.01 | — |
| RI | NU | $2.20 | $2.61 |
| SC | NU | $2.20 | $2.61 |
| SD | NU | $2.20 | $2.61 |
| TN | NU | $2.20 | $2.38 |
| TX | NU | $2.20 | $2.42 |
| UT | NU | $2.20 | $2.38 |
| VA | NU | $2.20 | $2.38 |
| VI | NU | $2.38 | — |
| VT | NU | $2.20 | $2.49 |
| WA | NU | $2.20 | $2.38 |
| WI | NU | $2.20 | $2.61 |
| WV | NU | $2.20 | $2.61 |
| WY | NU | $2.20 | $2.51 |
| AK | RR | $0.35 | — |
| AL | RR | $0.22 | $0.29 |
| AR | RR | $0.22 | $0.32 |
| AZ | RR | $0.22 | $0.32 |
| CA | RR | $0.22 | $0.32 |
| CO | RR | $0.22 | $0.29 |
| CT | RR | $0.22 | $0.32 |
| DC | RR | $0.22 | $0.29 |
| DE | RR | $0.22 | $0.29 |
| FL | RR | $0.22 | $0.29 |
| GA | RR | $0.22 | $0.29 |
| HI | RR | $0.37 | — |
| IA | RR | $0.22 | $0.32 |
| ID | RR | $0.22 | $0.29 |
| IL | RR | $0.22 | $0.32 |
| IN | RR | $0.22 | $0.29 |
| KS | RR | $0.22 | $0.32 |
| KY | RR | $0.22 | $0.32 |
| LA | RR | $0.22 | $0.32 |
| MA | RR | $0.22 | $0.32 |
| MD | RR | $0.22 | $0.32 |
| ME | RR | $0.22 | $0.32 |
| MI | RR | $0.22 | $0.29 |
| MN | RR | $0.22 | $0.32 |
| MO | RR | $0.22 | $0.32 |
| MS | RR | $0.22 | $0.31 |
| MT | RR | $0.22 | $0.29 |
| NC | RR | $0.22 | $0.32 |
| ND | RR | $0.22 | $0.32 |
| NE | RR | $0.22 | $0.32 |
| NH | RR | $0.22 | $0.29 |
| NJ | RR | $0.22 | $0.32 |
| NM | RR | $0.22 | $0.29 |
| NV | RR | $0.22 | $0.32 |
| NY | RR | $0.22 | $0.29 |
| OH | RR | $0.22 | $0.32 |
| OK | RR | $0.22 | $0.32 |
| OR | RR | $0.22 | $0.32 |
| PA | RR | $0.22 | $0.29 |
| PR | RR | $0.35 | — |
| RI | RR | $0.22 | $0.32 |
| SC | RR | $0.22 | $0.29 |
| SD | RR | $0.22 | $0.32 |
| TN | RR | $0.22 | $0.29 |
| TX | RR | $0.22 | $0.29 |
| UT | RR | $0.22 | $0.29 |
| VA | RR | $0.22 | $0.29 |
| VI | RR | $0.29 | — |
| VT | RR | $0.22 | $0.29 |
| WA | RR | $0.22 | $0.29 |
| WI | RR | $0.22 | $0.32 |
| WV | RR | $0.22 | $0.32 |
| WY | RR | $0.22 | $0.30 |
| AK | UE | $2.49 | — |
| AL | UE | $1.66 | $1.80 |
| AR | UE | $1.66 | $1.97 |
| AZ | UE | $1.66 | $1.80 |
| CA | UE | $1.66 | $1.97 |
| CO | UE | $1.66 | $1.97 |
| CT | UE | $1.66 | $1.97 |
| DC | UE | $1.66 | $1.86 |
| DE | UE | $1.66 | $1.87 |
| FL | UE | $1.66 | $1.80 |
| GA | UE | $1.66 | $1.80 |
| HI | UE | $2.60 | — |
| IA | UE | $1.66 | $1.97 |
| ID | UE | $1.66 | $1.80 |
| IL | UE | $1.66 | $1.97 |
| IN | UE | $1.66 | $1.90 |
| KS | UE | $1.66 | $1.97 |
| KY | UE | $1.66 | $1.97 |
| LA | UE | $1.66 | $1.97 |
| MA | UE | $1.66 | $1.97 |
| MD | UE | $1.66 | $1.97 |
| ME | UE | $1.66 | $1.97 |
| MI | UE | $1.66 | $1.80 |
| MN | UE | $1.66 | $1.80 |
| MO | UE | $1.66 | $1.97 |
| MS | UE | $1.66 | $1.97 |
| MT | UE | $1.66 | $1.80 |
| NC | UE | $1.66 | $1.97 |
| ND | UE | $1.66 | $1.97 |
| NE | UE | $1.66 | $1.97 |
| NH | UE | $1.66 | $1.87 |
| NJ | UE | $1.66 | $1.97 |
| NM | UE | $1.66 | $1.80 |
| NV | UE | $1.66 | $1.80 |
| NY | UE | $1.66 | $1.83 |
| OH | UE | $1.66 | $1.97 |
| OK | UE | $1.66 | $1.97 |
| OR | UE | $1.66 | $1.97 |
| PA | UE | $1.66 | $1.85 |
| PR | UE | $2.24 | — |
| RI | UE | $1.66 | $1.97 |
| SC | UE | $1.66 | $1.97 |
| SD | UE | $1.66 | $1.97 |
| TN | UE | $1.66 | $1.80 |
| TX | UE | $1.66 | $1.83 |
| UT | UE | $1.66 | $1.80 |
| VA | UE | $1.66 | $1.80 |
| VI | UE | $1.83 | — |
| VT | UE | $1.66 | $1.87 |
| WA | UE | $1.66 | $1.80 |
| WI | UE | $1.66 | $1.97 |
| WV | UE | $1.66 | $1.97 |
| WY | UE | $1.66 | $1.88 |
How the A4637 fee compares
| Measure | Value |
|---|---|
| Rank among 13 A46 codes billed NU (lowest = 1) | 1 |
| Family fee range (average of state fees) | $2.30–$66.87 |
| Rural fee uplift | 5.6% |
Who bills A4637 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 25 |
| Referring clinicians | 115 |
| Medicare beneficiaries | 193 |
| States with claims | 2 |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 38 | 211 |
| 2023 | 39 | 177 |
| 2024 | 25 | 193 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for A4637, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 403 | 211 | $2.12 | $1.62 |
| 2023 | 381 | 177 | $2.33 | $1.75 |
| 2024 | 416 | 193 | $2.40 | $1.73 |
States with the most A4637 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| California | 193 | $1.63 |
| Alaska | 162 | $2.05 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| DME suppliers | 4 | 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 A4637
- 2026-01-01: Average state fee (NU) rose 2.6%: $2.24 to $2.30
- 2026-01-01: Average state fee (RR) rose 0.5%: $0.23 to $0.23
- 2026-01-01: Average state fee (UE) rose 2.9%: $1.69 to $1.74
- 1991-01-01: A4637 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 A4637?
A4637 is the HCPCS Level II code for replacement, tip, cane, crutch, walker, each.. Short descriptor: "Repl tip cane/crutch/walker".
How much does Medicare pay for A4637?
Under the 2026 DMEPOS fee schedule, non-rural state fees are NU (new equipment, purchased): $2.20–$3.48; RR (rental (monthly)): $0.22–$0.37; UE (used equipment, purchased): $1.66–$2.60. Rural fees can be higher.
Does Medicare cover A4637?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
Did the Medicare fee for A4637 change in 2026?
The average non-rural state fee for NU moved from $2.24 in 2025 to $2.30 in 2026 (+2.6%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of A4637 can be billed per day?
4 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 A4637
- Watch A4637 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for A4637
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.