Replacement pad for use with medically necessary alternating pressure pad owned by patient
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 0 units per day (clinical), rationale: CMS Policy
DME supplier: max 1 units per day (policy), rationale: Code Descriptor / CPT Instruction
Medicare pricing for A4640
DMEPOS fee schedule, July 2026 (DME26-C)
NU (purchased, new), inexpensive or routinely purchased (IN): non-rural $58.10 to $72.47 in the contiguous states; $78.69 to $93.30 in AK, HI, PR and VI; rural $74.59 to $81.35
RR (rental), inexpensive or routinely purchased (IN): non-rural $5.81 to $7.25 in the contiguous states; $6.88 to $10.69 in AK, HI, PR and VI; rural $7.53 to $8.22
UE (purchased, used), inexpensive or routinely purchased (IN): non-rural $43.58 to $54.35 in the contiguous states; $57.57 to $69.96 in AK, HI, PR and VI; rural $54.35 to $59.15
Physician Fee Schedule (CY 2026, RVU26D)
Status X: statutory exclusion, not paid under the PFS.
Payer policies and prior authorization for A4640
1 of 1 payer prior-auth lists that name A4640 require prior authorization or set conditions: Rocky Mountain Health Plans.
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.