A4604 Medicare Reimbursement Rate (2026)
Current CMS pricing and breakdown for Tubing with integrated heating element for use with positive....
A4604 Reimbursement Rate History
| Quarter | Q1 2025 | Q2 2025 | Q3 2025 | Q4 2025 | Q1 2026 | Q2 2026 |
|---|---|---|---|---|---|---|
| National Average Payment | $50.32 | $50.32 | $50.32 | $50.32 | $51.66 | $51.66 |
⚠️ This is a National Estimate
Your actual reimbursement depends on your specific Zip Code and GPCI adjustments (e.g., New York vs. Texas).
Code Description
Tubing with integrated heating element for use with positive airway pressure device
Reimbursement Summary
CPT code A4604 (Tubing with integrated heating element for use with positive airway pressure device) had a 2026 Medicare non-facility reimbursement rate of $51.66. This reflects a 2.66% change from the prior year.
The 2026 National Medicare reimbursement estimate for A4604 is $51.66. Actual payment can vary by locality, setting, and claim specifics.
Description: Tubing with integrated heating element for use with positive airway pressure device. For locality-adjusted estimates, use MedFeeSchedule's Medicare Physician Fee Schedule Lookup Tool.
A4604 Reimbursement Rate History
| Quarter | Q1 2025 | Q2 2025 | Q3 2025 | Q4 2025 | Q1 2026 | Q2 2026 |
|---|---|---|---|---|---|---|
| National Average Payment | $50.32 | $50.32 | $50.32 | $50.32 | $51.66 | $51.66 |
Historical Medicare Reimbursement
| Quarter | Non-Facility Rate | Facility Rate | YoY % Change (Non-Fac) | YoY % Change (Fac) |
|---|---|---|---|---|
| 2026 Q2 | $51.66 | $51.66 | +2.66% | +2.66% |
| 2026 Q1 | $51.66 | $51.66 | +2.66% | +2.66% |
| 2025 Q4 | $50.32 | $50.32 | — | — |
| 2025 Q3 | $50.32 | $50.32 | — | — |
| 2025 Q2 | $50.32 | $50.32 | — | — |
| 2025 Q1 | $50.32 | $50.32 | — | — |
Facility vs. Non-Facility (Office) Payment
Facility vs. non-facility pricing most commonly applies to physician services paid under the RVU-based Physician Fee Schedule. For A4604 (DMEPOS Equipment), the payment methodology may not include both facility and non-facility rates.
Q2 2026 Breakdown
| Component | Office (Non-Fac) | Facility (Hosp) |
|---|---|---|
| Work RVU | ||
| Practice Expense (PE) | ||
| Malpractice (MP) | ||
| Total RVUs | 0.00 | 0.00 |
Learn How This Reimbursement Is Calculated
Medicare reimbursement is determined by RVUs, geographic adjustments, and the annual conversion factor.
Frequently Asked Questions
What is the 2026 Medicare rate for A4604?
The 2026 National Average Medicare reimbursement rate for A4604 (DMEPOS Equipment) is $51.66. This rate is effective as of January 1, 2026.
What is the description for code A4604?
Tubing with integrated heating element for use with positive airway pressure device
Why do facility and non-facility payments differ for A4604?
Facility vs. non-facility differences usually apply to RVU-based physician services. A4604 may not use both facility and non-facility pricing depending on its payment methodology.
How can I find my local Medicare rate for A4604?
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.
Is A4604 covered by Medicare?
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.
