Medicare coverage: Special coverage instructions apply
Status: active (October 2026 file)
Medically Unlikely Edits (effective October 1, 2026)
Practitioner: max 0 units per day (clinical), rationale: CMS Policy
Outpatient hospital: max 1 units per day (clinical), rationale: Clinical: Data
DME supplier: max 3 units per day (clinical), rationale: Published Contractor Policy
Medicare pricing for A4367
DMEPOS fee schedule, July 2026 (DME26-C)
no modifier, ostomy, tracheostomy and urological (OS): non-rural $8.92 to $10.49 in the contiguous states; $9.75 to $10.72 in AK, HI, PR and VI; ceiling $10.49, floor $8.92
Physician Fee Schedule (CY 2026, RVU26D)
Status P: bundled or excluded, no separate PFS payment.
Payer policies and prior authorization for A4367
1 of 1 payer prior-auth lists that name A4367 require prior authorization or set conditions: Passport by Molina Healthcare (Kentucky).
From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.