A7018 HCPCS code: Water, distilled, used with large volume nebulizer, 1000 ml
A7018 is the HCPCS Level II code for water, distilled, used with large volume nebulizer, 1000 ml. The 2026 Medicare DMEPOS fee schedule pays $0.38 to $0.59 depending on the state. Its Medicare coverage code is C (Carrier judgment): Coverage is decided by the Medicare contractor (MAC) case by case. Medicare volume fell 51% from 2022 to 2024 (8,454 to 4,176 services). In 2024, 22 suppliers billed Medicare for A7018 (purchases), serving 85 beneficiaries; Illinois, Ohio, Missouri accounted for 90% of services. Its average fee ranks 1 of 4 A70 codes (family range $0.41–$107.55); rural fees run 16% 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 | 2001-01-01 |
| Last action effective | 2001-01-01 |
2026 Medicare DMEPOS fee schedule for A7018
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $0.38 | $0.59 | — | — |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $0.56 | — |
| AL | — | $0.41 | $0.45 |
| AR | — | $0.41 | $0.45 |
| AZ | — | $0.38 | $0.49 |
| CA | — | $0.39 | $0.49 |
| CO | — | $0.39 | $0.45 |
| CT | — | $0.43 | $0.49 |
| DC | — | $0.41 | $0.49 |
| DE | — | $0.41 | $0.49 |
| FL | — | $0.41 | $0.45 |
| GA | — | $0.41 | $0.45 |
| HI | — | $0.59 | — |
| IA | — | $0.39 | $0.49 |
| ID | — | $0.39 | $0.49 |
| IL | — | $0.44 | $0.49 |
| IN | — | $0.44 | $0.49 |
| KS | — | $0.39 | $0.49 |
| KY | — | $0.41 | $0.45 |
| LA | — | $0.41 | $0.45 |
| MA | — | $0.43 | $0.49 |
| MD | — | $0.41 | $0.49 |
| ME | — | $0.43 | $0.49 |
| MI | — | $0.44 | $0.49 |
| MN | — | $0.39 | $0.49 |
| MO | — | $0.39 | $0.49 |
| MS | — | $0.41 | $0.45 |
| MT | — | $0.39 | $0.49 |
| NC | — | $0.41 | $0.45 |
| ND | — | $0.39 | $0.49 |
| NE | — | $0.39 | $0.49 |
| NH | — | $0.43 | $0.49 |
| NJ | — | $0.41 | $0.49 |
| NM | — | $0.38 | $0.45 |
| NV | — | $0.39 | $0.49 |
| NY | — | $0.41 | $0.49 |
| OH | — | $0.44 | $0.49 |
| OK | — | $0.38 | $0.45 |
| OR | — | $0.39 | $0.49 |
| PA | — | $0.41 | $0.49 |
| PR | — | $0.40 | — |
| RI | — | $0.43 | $0.49 |
| SC | — | $0.41 | $0.45 |
| SD | — | $0.39 | $0.49 |
| TN | — | $0.41 | $0.45 |
| TX | — | $0.38 | $0.45 |
| UT | — | $0.39 | $0.49 |
| VA | — | $0.41 | $0.49 |
| VI | — | $0.49 | — |
| VT | — | $0.43 | $0.49 |
| WA | — | $0.39 | $0.49 |
| WI | — | $0.44 | $0.49 |
| WV | — | $0.41 | $0.49 |
| WY | — | $0.39 | $0.49 |
How the A7018 fee compares
| Measure | Value |
|---|---|
| Rank among 4 A70 codes (lowest = 1) | 1 |
| Family fee range (average of state fees) | $0.41–$107.55 |
| Rural fee uplift | 15.5% |
Who bills A7018 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 22 |
| Referring clinicians | 89 |
| Medicare beneficiaries | 85 |
| States with claims | 6 |
| Share of services in top 3 states (Illinois, Ohio, Missouri) | 90% |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 30 | 173 |
| 2023 | 22 | 121 |
| 2024 | 22 | 85 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for A7018, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 8,454 | 173 | $0.38 | $0.29 |
| 2023 | 7,648 | 121 | $0.42 | $0.31 |
| 2024 | 4,176 | 85 | $0.41 | $0.30 |
States with the most A7018 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Illinois | 2,673 | $0.28 |
| Ohio | 503 | $0.32 |
| Missouri | 210 | $0.30 |
| Arizona | 156 | $0.33 |
| Maryland | 123 | $0.31 |
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 A7018
- 2026-01-01: Average state fee rose 2.5%: $0.40 to $0.41
- 2001-01-01: A7018 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 A7018?
A7018 is the HCPCS Level II code for water, distilled, used with large volume nebulizer, 1000 ml. Short descriptor: "Water distilled w/nebulizer".
How much does Medicare pay for A7018?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $0.38–$0.59. Rural fees can be higher.
Does Medicare cover A7018?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Which diagnoses support coverage for A7018?
Medicare policy articles that cite A7018 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 A7018 change in 2026?
The average non-rural state fee moved from $0.40 in 2025 to $0.41 in 2026 (+2.5%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
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)
- A7004 — Small volume nonfiltered pneumatic nebulizer, disposable ($1.51–$2.08)
- 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
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 A7018
- Watch A7018 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for A7018
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.