A4459 — Manual transanal irrigation system, includes water reservoir, pump, tubing, and accessories, without catheter, any type

Medicare coverage: Carrier judgment

Coverage is decided by your Medicare contractor, not by national policy. Whether this is paid depends on the LCD for your jurisdiction and on what the documentation supports.

From the coverage field of the CMS Alpha-Numeric HCPCS File, release 2026Q3-Jul. This states Medicare’s position on the code, not on your particular claim.

Physician fee schedule statusX

Statutory exclusion. The item or service is not within the statutory definition of 'physician services', so the fee schedule never pays it.

Global period: XXX

Want the dollar amount for your locality? The fee calculator applies your GPCI and the current conversion factor.

Medically Unlikely Edits — units per day

The most units of A4459 Medicare will pay on one date of service. Bill more on a single line and it is denied. The limit is not the same in every setting, so the row that matters is the one matching the claim you are building.

practitioner

0 — never payable

MAI 3 — Date of Service Edit: Clinical · CMS Policy

outpatient

1 unit

MAI 3 — Date of Service Edit: Clinical · Nature of Equipment

DME supplier

1 unit

MAI 3 — Date of Service Edit: Clinical · Nature of Equipment

The adjudication indicator decides whether exceeding the limit is worth appealing at all: MAI 1 is a line edit you can support with documentation, MAI 3 is a date-of-service edit that is also appealable, and MAI 2 is absolute — no documentation overrides it. CMS MUE 2026Q3.