Traditional MedicareBilling CodesLow impact
R13988CP: Annual Update of Healthcare Common Procedure Coding System (HCPCS) Codes Used for Home Health Consolidated Billing Enforcement
Medicare/CMS - Transmittals·CMS Transmittal
Effective date
Jan 1, 2027
We identified it
Oct 10, 2026
Summary
CMS is removing two HCPCS codes (A4453 and A4459) from the Home Health consolidated billing non-routine supply code list, effective January 1, 2027. This means these rectal catheter and enema system codes will no longer be subject to consolidated billing restrictions for home health episodes, allowing separate billing under certain conditions.
Action Required
By January 1, 2027: Billing team must update billing system software and claims processing edits to remove HCPCS codes A4453 and A4459 from the Home Health consolidated billing non-routine supply code enforcement list. For claims with line item dates of service on or after January 1, 2027, these codes should no longer trigger consolidated billing denials for home health episodes. Implementation date for contractor systems is January 4, 2027. Verify with your Medicare Administrative Contractor (MAC) that this update has been applied to your claims processing system before the effective date.