HCPCS Level II › A codes A4615 Cannula nasalCannula, nasal
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 2 units per day (clinical), rationale: Clinical: Data DME supplier: max 0 units per day (clinical), rationale: Published Contractor Policy Medicare pricing for A4615 DMEPOS fee schedule, July 2026 (DME26-C) no modifier, supplies (SU): non-rural $1.04 in the contiguous states; $1.04 to $1.25 in AK, HI, PR and VI; ceiling $1.04, floor $0.88 Physician Fee Schedule (CY 2026, RVU26D) Status X: statutory exclusion, not paid under the PFS.
Payer policies and prior authorization for A4615 Payer coverage policies that name A4615 A4615 appears in 4 coverage policies from Aetna, Anthem, Blue Cross & Blue Shield of Mississippi, BlueCross BlueShield of South Carolina.
Payer Policy Role in policy Reviewed Document Aetna Oxygen (0002) listed, no stance Mar 10, 2026 payer document Anthem Home Oxygen Therapy (CG-DME-18)Supplies covered if criteria are met Aug 13, 2026 payer document Blue Cross & Blue Shield of Mississippi Oxygen (L.1.01.403) covered if criteria are met payer document BlueCross BlueShield of South Carolina Oxygen Therapy (CAM 10112)799.2 | Insomnia listed, no stance (range A4606-A4629) Jul 1, 2026 payer document
Medicaid fee-for-service Prior authorization required or conditional in IL, IN, LA, VA.
AZ: $1.24 (dme), effective Oct 1, 2026 CO: $0.76 (chp_plus, non-facility), effective Jul 1, 2026 IL: $1.43 (dme), effective Jan 1, 2026 IN: $0.87 (professional, Advanced Practice Nurse (85%), non-facility), effective Jan 1, 2026 KS: $0.83 (default), effective Jul 1, 2026 MA: $0.85 (dme_rates), effective Mar 1, 2026 MD: $0.88 (dme), effective Apr 1, 2026 MS: $0.83 (comprehensive), effective Jul 1, 2026 ND: $2.91 (dme), effective Aug 1, 2026 NE: $0.89 (dme), effective Jul 1, 2026 NY: $0.76 (dme), effective Jul 1, 2026 OH: $0.70 (dme), effective Jan 1, 2024 OK: $1.04 (dme), effective Jan 1, 2026 TX: $0.75 (dmepos_tos_9_e_j_l_and_r, Home Health Dme, non-facility), effective Jul 1, 2011 VA: $0.94 (dme), effective Dec 1, 2026 VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $0.77 (respiratory), effective Jul 1, 2026 WY: $0.00 (outpatient_hospital_apc, Children's Hospitals), effective Apr 1, 2026 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.