A7028 HCPCS code: Oral cushion for combination oral/nasal mask, replacement only, each
A7028 is the HCPCS Level II code for oral cushion for combination oral/nasal mask, replacement only, each. The 2026 Medicare DMEPOS fee schedule pays $40.30 to $66.05 (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 95% from 2022 to 2024 (8,254 to 431 services). In 2024, 46 suppliers billed Medicare for A7028 (purchases), serving 81 beneficiaries. Its average fee ranks 27 of 37 A70 codes billed NU (family range $0.71–$172.96); rural fees run 35% 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 | 2008-01-01 |
| Last action effective | 2008-01-01 |
2026 Medicare DMEPOS fee schedule for A7028
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| NU | new equipment, purchased | $40.30 | $66.05 | — | — |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | NU | $58.99 | — |
| AL | NU | $42.97 | $58.64 |
| AR | NU | $42.97 | $58.64 |
| AZ | NU | $40.86 | $58.64 |
| CA | NU | $41.72 | $58.64 |
| CO | NU | $41.64 | $58.64 |
| CT | NU | $41.59 | $58.64 |
| DC | NU | $40.30 | $58.64 |
| DE | NU | $40.30 | $58.64 |
| FL | NU | $42.97 | $58.64 |
| GA | NU | $42.97 | $58.64 |
| HI | NU | $58.99 | — |
| IA | NU | $43.48 | $58.64 |
| ID | NU | $41.64 | $58.64 |
| IL | NU | $43.27 | $58.64 |
| IN | NU | $43.27 | $58.64 |
| KS | NU | $43.48 | $58.64 |
| KY | NU | $42.97 | $58.64 |
| LA | NU | $42.97 | $58.64 |
| MA | NU | $41.59 | $58.64 |
| MD | NU | $40.30 | $58.64 |
| ME | NU | $41.59 | $58.64 |
| MI | NU | $43.27 | $58.64 |
| MN | NU | $43.48 | $58.64 |
| MO | NU | $43.48 | $58.64 |
| MS | NU | $42.97 | $58.64 |
| MT | NU | $41.64 | $58.64 |
| NC | NU | $42.97 | $58.64 |
| ND | NU | $43.48 | $58.64 |
| NE | NU | $43.48 | $58.64 |
| NH | NU | $41.59 | $58.64 |
| NJ | NU | $40.30 | $58.64 |
| NM | NU | $40.86 | $58.64 |
| NV | NU | $41.72 | $58.64 |
| NY | NU | $40.30 | $58.64 |
| OH | NU | $43.27 | $58.64 |
| OK | NU | $40.86 | $58.64 |
| OR | NU | $41.72 | $58.64 |
| PA | NU | $40.30 | $58.64 |
| PR | NU | $66.05 | — |
| RI | NU | $41.59 | $58.64 |
| SC | NU | $42.97 | $58.64 |
| SD | NU | $43.48 | $58.64 |
| TN | NU | $42.97 | $58.64 |
| TX | NU | $40.86 | $58.64 |
| UT | NU | $41.64 | $58.64 |
| VA | NU | $42.97 | $58.64 |
| VI | NU | $58.99 | — |
| VT | NU | $41.59 | $58.64 |
| WA | NU | $41.72 | $58.64 |
| WI | NU | $43.27 | $58.64 |
| WV | NU | $42.97 | $58.64 |
| WY | NU | $41.64 | $58.64 |
How the A7028 fee compares
| Measure | Value |
|---|---|
| Rank among 37 A70 codes billed NU (lowest = 1) | 27 |
| Family fee range (average of state fees) | $0.71–$172.96 |
| Rural fee uplift | 34.6% |
Who bills A7028 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 46 |
| Referring clinicians | 72 |
| Medicare beneficiaries | 81 |
| States with claims | 3 |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 515 | 877 |
| 2023 | 276 | 457 |
| 2024 | 46 | 81 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for A7028, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 8,254 | 877 | $39.93 | $30.29 |
| 2023 | 2,959 | 457 | $43.05 | $31.52 |
| 2024 | 431 | 81 | $43.99 | $33.19 |
States with the most A7028 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Mississippi | 143 | $32.13 |
| Louisiana | 31 | $38.81 |
| Missouri | 26 | $40.12 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| DME suppliers | 6 | Published Contractor Policy |
What changed for A7028
- 2026-01-01: Average state fee (NU) rose 2.7%: $42.44 to $43.57
- 2008-01-01: A7028 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 A7028?
A7028 is the HCPCS Level II code for oral cushion for combination oral/nasal mask, replacement only, each. Short descriptor: "Repl oral cushion combo mask".
How much does Medicare pay for A7028?
Under the 2026 DMEPOS fee schedule, non-rural state fees are NU (new equipment, purchased): $40.30–$66.05. Rural fees can be higher.
Does Medicare cover A7028?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Did the Medicare fee for A7028 change in 2026?
The average non-rural state fee for NU moved from $42.44 in 2025 to $43.57 in 2026 (+2.7%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of A7028 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)
- 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 A7028
- Watch A7028 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for A7028
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.