A7004 HCPCS code: Small volume nonfiltered pneumatic nebulizer, disposable
A7004 is the HCPCS Level II code for small volume nonfiltered pneumatic nebulizer, disposable. The 2026 Medicare DMEPOS fee schedule pays $1.51 to $2.08 (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 6 per day on DME suppliers. Medicare volume fell 57% from 2022 to 2024 (58,439 to 25,045 services). In 2024, 193 suppliers billed Medicare for A7004 (purchases), serving 3,798 beneficiaries; Alabama, Mississippi, Kansas accounted for 33% of services. Its average fee ranks 2 of 37 A70 codes billed NU (family range $0.71–$172.96); rural fees run 29% higher.
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 | 2000-01-01 |
| Last action effective | 2000-01-01 |
2026 Medicare DMEPOS fee schedule for A7004
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| NU | new equipment, purchased | $1.51 | $2.08 | — | — |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | NU | $2.01 | — |
| AL | NU | $1.59 | $1.96 |
| AR | NU | $1.59 | $1.96 |
| AZ | NU | $1.57 | $2.15 |
| CA | NU | $1.59 | $2.15 |
| CO | NU | $1.51 | $1.96 |
| CT | NU | $1.55 | $1.97 |
| DC | NU | $1.56 | $2.15 |
| DE | NU | $1.56 | $1.96 |
| FL | NU | $1.59 | $1.96 |
| GA | NU | $1.59 | $1.96 |
| HI | NU | $2.08 | — |
| IA | NU | $1.58 | $2.15 |
| ID | NU | $1.51 | $2.15 |
| IL | NU | $1.58 | $2.15 |
| IN | NU | $1.58 | $2.15 |
| KS | NU | $1.58 | $2.15 |
| KY | NU | $1.59 | $1.96 |
| LA | NU | $1.59 | $1.96 |
| MA | NU | $1.55 | $1.97 |
| MD | NU | $1.56 | $2.15 |
| ME | NU | $1.55 | $2.01 |
| MI | NU | $1.58 | $2.15 |
| MN | NU | $1.58 | $2.15 |
| MO | NU | $1.58 | $2.15 |
| MS | NU | $1.59 | $1.96 |
| MT | NU | $1.51 | $2.15 |
| NC | NU | $1.59 | $1.96 |
| ND | NU | $1.58 | $2.15 |
| NE | NU | $1.58 | $2.15 |
| NH | NU | $1.55 | $1.96 |
| NJ | NU | $1.56 | $1.96 |
| NM | NU | $1.57 | $1.96 |
| NV | NU | $1.59 | $2.15 |
| NY | NU | $1.56 | $1.96 |
| OH | NU | $1.58 | $2.15 |
| OK | NU | $1.57 | $1.96 |
| OR | NU | $1.59 | $2.15 |
| PA | NU | $1.56 | $1.96 |
| PR | NU | $1.72 | — |
| RI | NU | $1.55 | $1.96 |
| SC | NU | $1.59 | $1.96 |
| SD | NU | $1.58 | $2.15 |
| TN | NU | $1.59 | $1.96 |
| TX | NU | $1.57 | $1.96 |
| UT | NU | $1.51 | $2.15 |
| VA | NU | $1.59 | $2.15 |
| VI | NU | $1.96 | — |
| VT | NU | $1.55 | $1.96 |
| WA | NU | $1.59 | $2.15 |
| WI | NU | $1.58 | $2.15 |
| WV | NU | $1.59 | $2.15 |
| WY | NU | $1.51 | $2.15 |
How the A7004 fee compares
| Measure | Value |
|---|---|
| Rank among 37 A70 codes billed NU (lowest = 1) | 2 |
| Family fee range (average of state fees) | $0.71–$172.96 |
| Rural fee uplift | 28.9% |
Who bills A7004 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 193 |
| Referring clinicians | 2,861 |
| Medicare beneficiaries | 3,798 |
| States with claims | 44 |
| Share of services in top 3 states (Alabama, Mississippi, Kansas) | 33% |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 265 | 7,952 |
| 2023 | 217 | 6,235 |
| 2024 | 193 | 3,798 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for A7004, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 58,439 | 7,952 | $1.55 | $1.12 |
| 2023 | 43,850 | 6,235 | $1.67 | $1.19 |
| 2024 | 25,045 | 3,798 | $1.69 | $1.19 |
States with the most A7004 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Alabama | 3,198 | $1.16 |
| Mississippi | 2,572 | $1.25 |
| Kansas | 2,465 | $1.33 |
| California | 2,366 | $1.11 |
| Texas | 1,545 | $1.13 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| DME suppliers | 6 | Published Contractor Policy |
Medicare policy articles for this code
- A52466: Nebulizers - Policy Article (CGS Administrators, LLC (DME MAC) Noridian Healthcare Solutions, LLC (DME MAC)) — mentions this code in its coding guidance
Covered diagnoses (215 ICD-10-CM codes)
The diagnoses most often listed as covered in the policy articles above:
| ICD-10-CM | Diagnosis | Articles listing it |
|---|---|---|
| A15.0 | Tuberculosis of lung | 1 |
| A22.1 | Pulmonary anthrax | 1 |
| A37.01 | Whooping cough due to Bordetella pertussis with pneumonia | 1 |
| A37.11 | Whooping cough due to Bordetella parapertussis with pneumonia | 1 |
| A37.81 | Whooping cough due to other Bordetella species with pneumonia | 1 |
| A37.91 | Whooping cough, unspecified species with pneumonia | 1 |
| A48.1 | Legionnaires' disease | 1 |
| B20 | Human immunodeficiency virus [HIV] disease | 1 |
| B25.0 | Cytomegaloviral pneumonitis | 1 |
| B44.0 | Invasive pulmonary aspergillosis | 1 |
Showing 10 of 215. The full list, non-covered diagnoses and CSV export are in Caduvo.
What changed for A7004
- 2026-01-01: Average state fee (NU) rose 2.7%: $1.56 to $1.60
- 2000-01-01: A7004 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 A7004?
A7004 is the HCPCS Level II code for small volume nonfiltered pneumatic nebulizer, disposable. Short descriptor: "Disposable nebulizer sml vol".
How much does Medicare pay for A7004?
Under the 2026 DMEPOS fee schedule, non-rural state fees are NU (new equipment, purchased): $1.51–$2.08. Rural fees can be higher.
Does Medicare cover A7004?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Which diagnoses support coverage for A7004?
Medicare policy articles that cite A7004 list 215 covered ICD-10-CM diagnosis codes across 1 article. The most cited include A15.0 (Tuberculosis of lung), A22.1 (Pulmonary anthrax), A37.01 (Whooping cough due to Bordetella pertussis with pneumonia). A listed diagnosis is necessary but not sufficient; the policy's other criteria still apply.
Did the Medicare fee for A7004 change in 2026?
The average non-rural state fee for NU moved from $1.56 in 2025 to $1.60 in 2026 (+2.7%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of A7004 can be billed per day?
6 on DME suppliers (NCCI medically unlikely edits).
Related A70 codes
- A7000 — Canister, disposable, used with suction pump, each ($9.24–$13.39)
- A7001 — Canister, non-disposable, used with suction pump, each ($40.06–$47.58)
- A7002 — Tubing, used with suction pump, each ($3.87–$5.47)
- A7003 — Administration set, with small volume nonfiltered pneumatic nebulizer, disposable ($1.86–$3.26)
- A7005 — Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable ($11.77–$29.20)
- A7006 — Administration set, with small volume filtered pneumatic nebulizer ($8.19–$14.94)
- A7007 — Large volume nebulizer, disposable, unfilled, used with aerosol compressor ($3.47–$5.87)
- A7008 — Large volume nebulizer, disposable, prefilled, used with aerosol compressor ($12.46–$18.09)
- A7009 — Reservoir bottle, non-disposable, used with large volume ultrasonic nebulizer ($54.00–$66.77)
- A7010 — Corrugated tubing, disposable, used with large volume nebulizer, 100 feet ($17.61–$27.19)
- A7011 — Corrugated tubing, non-disposable, used with large volume nebulizer, 10 feet
- A7012 — Water collection device, used with large volume nebulizer ($3.25–$5.03)
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 A7004
- Watch A7004 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for A7004
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.