A4459
Prosthetics & Orthotics
53 States
Manual transanal irrigation system, includes water reservoir, pump, tubing, and accessories, without catheter, any type
Short Desc
Transanal irrigation, any
Coverage determined by local carrier discretion.
Added Date
2015-01-01
Effective From
2025-10-01
National Floor
$144.38
National Ceiling
$192.50
Fee Schedule Rates
Effective Jan 2026Official Medicare DMEPOS pricing for 2026.
| State | Modifier | Non-Rural | Rural |
|---|---|---|---|
|
AK
|
Base Rate |
$160.42
|
Same |
|
AL
|
Base Rate |
$160.42
|
Same |
|
AR
|
Base Rate |
$160.42
|
Same |
|
AZ
|
Base Rate |
$160.42
|
Same |
|
CA
|
Base Rate |
$160.42
|
Same |
|
CO
|
Base Rate |
$160.42
|
Same |
|
CT
|
Base Rate |
$160.42
|
Same |
|
DC
|
Base Rate |
$160.42
|
Same |
|
DE
|
Base Rate |
$160.42
|
Same |
|
FL
|
Base Rate |
$160.42
|
Same |
|
GA
|
Base Rate |
$160.42
|
Same |
|
HI
|
Base Rate |
$160.42
|
Same |
|
IA
|
Base Rate |
$160.42
|
Same |
|
ID
|
Base Rate |
$160.42
|
Same |
|
IL
|
Base Rate |
$160.42
|
Same |
|
IN
|
Base Rate |
$160.42
|
Same |
|
KS
|
Base Rate |
$160.42
|
Same |
|
KY
|
Base Rate |
$160.42
|
Same |
|
LA
|
Base Rate |
$160.42
|
Same |
|
MA
|
Base Rate |
$160.42
|
Same |
|
MD
|
Base Rate |
$160.42
|
Same |
|
ME
|
Base Rate |
$160.42
|
Same |
|
MI
|
Base Rate |
$160.42
|
Same |
|
MN
|
Base Rate |
$160.42
|
Same |
|
MO
|
Base Rate |
$160.42
|
Same |
|
MS
|
Base Rate |
$160.42
|
Same |
|
MT
|
Base Rate |
$160.42
|
Same |
|
NC
|
Base Rate |
$160.42
|
Same |
|
ND
|
Base Rate |
$160.42
|
Same |
|
NE
|
Base Rate |
$160.42
|
Same |
|
NH
|
Base Rate |
$160.42
|
Same |
|
NJ
|
Base Rate |
$160.42
|
Same |
|
NM
|
Base Rate |
$160.42
|
Same |
|
NV
|
Base Rate |
$160.42
|
Same |
|
NY
|
Base Rate |
$160.42
|
Same |
|
OH
|
Base Rate |
$160.42
|
Same |
|
OK
|
Base Rate |
$160.42
|
Same |
|
OR
|
Base Rate |
$160.42
|
Same |
|
PA
|
Base Rate |
$160.42
|
Same |
|
PR
|
Base Rate |
$160.42
|
Same |
|
RI
|
Base Rate |
$160.42
|
Same |
|
SC
|
Base Rate |
$160.42
|
Same |
|
SD
|
Base Rate |
$160.42
|
Same |
|
TN
|
Base Rate |
$160.42
|
Same |
|
TX
|
Base Rate |
$160.42
|
Same |
|
UT
|
Base Rate |
$160.42
|
Same |
|
VA
|
Base Rate |
$160.42
|
Same |
|
VI
|
Base Rate |
$160.42
|
Same |
|
VT
|
Base Rate |
$160.42
|
Same |
|
WA
|
Base Rate |
$160.42
|
Same |
|
WI
|
Base Rate |
$160.42
|
Same |
|
WV
|
Base Rate |
$160.42
|
Same |
|
WY
|
Base Rate |
$160.42
|
Same |