A4649 HCPCS code: Surgical supply; miscellaneous
A4649 is the HCPCS Level II code for surgical supply; miscellaneous. In 2024 Medicare paid an average of $308.80 per service for A4649 across 55 services. Its Medicare coverage code is C (Carrier judgment): Coverage is decided by the Medicare contractor (MAC) case by case. The NCCI unit limit is 8 per day on outpatient hospital claims. Medicare volume rose 53% from 2022 to 2024 (36 to 55 services). In 2024, about 13 clinicians billed Medicare for A4649 for 17 beneficiaries.
Code details
| Field | Value |
|---|---|
| Section | A codes — Transportation, medical/surgical supplies and miscellaneous |
| Coverage code | C — Carrier judgment |
| Pricing indicator | 46 — Priced by the Medicare contractor (no national fee) |
| BETOS category | D1A — Medical/surgical supplies |
| Added | 1982-01-01 |
| Last action effective | 1998-01-01 |
Who bills A4649 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 13 |
| Medicare beneficiaries | 17 |
| States with claims | 1 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for A4649, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 36 | 35 | $77.15 | $61.64 |
| 2023 | 15 | 15 | $149.29 | $118.95 |
| 2024 | 55 | 17 | $387.58 | $308.80 |
States with the most A4649 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Washington | 11 | $82.63 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 8 | Clinical: Data |
| practitioner claims | 1 | Clinical: Data |
Medicare policy articles for this code
- A52437: Billing and Coding: Sentinel Lymph Node Biopsy – Medical Policy Article (CGS Administrators, LLC (MAC - Part A, MAC - Part B))
What changed for A4649
- 1982-01-01: A4649 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 A4649?
A4649 is the HCPCS Level II code for surgical supply; miscellaneous. Short descriptor: "Surgical supplies".
How much does Medicare pay for A4649?
In 2024, the average Medicare payment was $308.80 per service (average allowed $387.58).
Does Medicare cover A4649?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
How many units of A4649 can be billed per day?
8 on outpatient hospital claims; 1 on practitioner 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 A4649
- Watch A4649 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for A4649
Sources: CMS HCPCS Level II release October 2025; CMS DMEPOS fee schedule; 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.