CMS establishes a Medicare fee schedule amount for A4479
Fee schedule · high importance
- Announced
- 2026-03-26
- Effective
- 2026-04-01
Under the heading New Fee Schedule Amounts, CMS states: "We added fee schedule amounts to the DMEPOS fee schedule file for new HCPCS codes, including: A4318, A4479". The change request carries an effective date of April 1, 2026 and an implementation date of April 6, 2026.
This is the event that dates the answer to how much Medicare pays for the electronic transanal irrigation system, and it is the reason a summary written before April 2026 will say that no rate had been published. The July 2026 file carries the amount unchanged.
How the amount was reached is a separate question and it is still open. The fee schedule file flags A4479 as needing the original base year amount gap-filled, with a base year amount of zero and no ceiling and no floor.
Codes this entry bears on
Sources
- [1] MLN Matters MM14425, DMEPOS Fee Schedule: April 2026 Quarterly Update · Centers for Medicare and Medicaid Services · checked 2026-08-07
Change Request 14425, release date 2026-03-26, effective 2026-04-01, implementation 2026-04-06, transmittal R13685CP. PDF, HTTP 200, 177,700 bytes, 4 pages, SHA-256 817fc91b93b1289f8ea9e4b2f36c33696a8227e666e882b1a10819332e008643, fetched and text-extracted on 2026-08-07; the date recorded above is the CR release date printed on page 1, and the article's own Document History gives 2026-03-31 as the date the initial article was released. This is CMS in its own words on the fact that refutes the "nobody has priced A4479" premise, under the heading New Fee Schedule Amounts: "We added fee schedule amounts to the DMEPOS fee schedule file for new HCPCS codes, including: A4318, A4479, A6544, A6548, L2221, L5657, L5992, L6028". It also names the review cycle these codes came through, the Second Biannual 2025 Non-Drug and Non-Biological Items and Services HCPCS code application review cycle, and points at "a narrative summary for the Medicare benefit category and payment determinations" whose embedded hyperlink resolves to https://www.cms.gov/medicare/coding-billing/healthcare-common-procedure-system/current-prior-years-level-ii-coding-decisions. That summary is the remaining lead on how the A4479 amount was derived and was not read. www.cms.gov answers some fetch libraries with HTTP 403 and serves normally to curl with a browser User-Agent.
- [2] DMEPOS Fee Schedule, July 2026 (file DME26-C) · Centers for Medicare and Medicaid Services · checked 2026-08-07
Effective 2026-07-01. Downloaded on 2026-08-07 from https://www.cms.gov/files/zip/dme26-c.zip, HTTP 200, 5,085,402 bytes, SHA-256 78bcc2956f2e00f70fb4016bd44be470fb34ac1cc65b7321aa25e8dadb8be478. Figures read independently from DMEPOS_JUL.csv and the fixed-width DMEPOS_JUL.txt inside it, which agree exactly. The A4297 amounts by state, all taken from the per-state non-rural column, which the record layout names UPDATED FEE SCHEDULE AMOUNT and describes as the amount used for pricing: 9.99 in AL AR AZ CA CO GA IA ID IN KS KY LA MI MN MO MS MT NC ND NE NM NV OK OR SC SD TN UT WA WI WY and VI; 9.97 in CT DE FL IL MA MD ME NH NJ NY OH PA RI TX VA VT WV and DC; 10.06 in AK; 10.75 in HI; 10.97 in PR. The record layout and methodology are documented in DMEREAD 2026.pdf and DMEBACK 2026.pdf inside the same zip. www.cms.gov returns HTTP 403 to some fetch libraries and serves normally to curl with a browser User-Agent; the file itself is served directly and no licence interstitial was submitted to obtain it.