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 3 units per day (policy), rationale: Published Contractor Policy
Medicare pricing for A7015
DMEPOS fee schedule, July 2026 (DME26-C)
NU (purchased, new), inexpensive or routinely purchased (IN): non-rural $1.46 to $1.65 in the contiguous states; $1.89 to $2.50 in AK, HI, PR and VI; rural $2.04 to $2.21
Physician Fee Schedule (CY 2026, RVU26D)
Status X: statutory exclusion, not paid under the PFS.
Payer policies and prior authorization for A7015
Payer coverage policies that name A7015
A7015 appears in 4 coverage policies from Aetna, Blue Cross & Blue Shield of Mississippi, Blue Cross & Blue Shield of Rhode Island.
Payer
Policy
Role in policy
Reviewed
Document
Aetna
Aerosolized or Irrigated Anti-infectives for Sinusitis (0593)
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.