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Current CMS pricing and breakdown for Vag inser rectal control sys.
National Medicare Payment
$1,672.60
This fee schedule does not publish separate facility and non-facility rates for this code.
Effective Q3 2026
The amounts shown are the published national payments. Local payment can vary based on your specific Zip Code, GPCI adjustments, and site of service.
Your actual reimbursement depends on your specific Zip Code and GPCI adjustments (e.g., New York vs. Texas).
| Quarter | National Medicare Payment | YoY % Change |
|---|---|---|
| 2026 Q3 | $1,672.60 | +2.00% |
| 2026 Q2 | $1,672.60 | +2.00% |
| 2026 Q1 | $1,678.70 | +2.37% |
| 2025 Q4 | $1,639.81 | — |
| 2025 Q3 | $1,639.81 | — |
| 2025 Q2 | $1,639.81 | — |
| 2025 Q1 | $1,639.81 | — |
Rectal control system for vaginal insertion, for long term use, includes pump and all supplies and accessories, any type each
CPT code A4563 (Rectal control system for vaginal insertion, for long term use, includes pump and all supplies and accessories, any type each) had a 2026 Medicare non-facility reimbursement rate of $1,672.60. This reflects a 2.00% change from the prior year.
The 2026 National Medicare reimbursement estimate for A4563 is $1,672.60. Actual payment can vary by locality, setting, and claim specifics.
Description: Rectal control system for vaginal insertion, for long term use, includes pump and all supplies and accessories, any type each. For locality-adjusted estimates, use MedFeeSchedule's Medicare Physician Fee Schedule Lookup Tool.
| Component | Office (Non-Fac) | Facility (Hosp) |
|---|---|---|
| Work RVU | ||
| Practice Expense (PE) | ||
| Malpractice (MP) | ||
| Total RVUs | 0.00 | 0.00 |
Compare a payment against the Medicare benchmark for this code.
Medicare rates are used as a benchmark only. Actual payer contracts, modifiers, place of service, units, and billing rules may affect reimbursement. This tool is for educational and operational review purposes, not legal or billing advice.
Facility vs. non-facility pricing most commonly applies to physician services paid under the RVU-based Physician Fee Schedule. For A4563 (DMEPOS Equipment), the payment methodology may not include both facility and non-facility rates.
Medicare reimbursement is determined by RVUs, geographic adjustments, and the annual conversion factor.
The 2026 National Average Medicare reimbursement rate for A4563 (DMEPOS Equipment) is $1,672.60. This rate is effective as of January 1, 2026.
Rectal control system for vaginal insertion, for long term use, includes pump and all supplies and accessories, any type each
Facility vs. non-facility differences usually apply to RVU-based physician services. A4563 may not use both facility and non-facility pricing depending on its payment methodology.
Use MedFeeSchedule's Medicare Physician Fee Schedule Lookup Tool on the homepage to estimate your locality-adjusted reimbursement. Medicare payment can vary based on geographic adjustments (GPCI), place of service, and claim specifics.
Coverage depends on medical necessity, setting, and Medicare policy. Some codes may be bundled, contractor-priced, or restricted. Verify final coverage guidance through CMS or your local MAC when applicable.