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Two supply codes come off the home health consolidated billing list on January 1, 2027

The short answer: CMS's 2027 consolidated billing update removes two supply codes, A4453 and A4459, from the home health non-routine supply list for dates of service on or after Jan. 1, 2027. After that, suppliers billing them for patients under a home health plan of care stop hitting consolidated billing edits. No therapy codes change.

A short annual update with one practical effect: suppliers billing these two items for patients under a home health plan of care stop running into consolidated billing edits on them.

By Published Last updated 5 sources linked
Two pairs of hands pass a cardboard box of medical supplies between them
Illustration: a medical supply shipment handed over during a 2025 aid mission. It is not related to CMS or a home health agency. Photo: Tech. Sgt. Ryan Green, U.S. Air Force / Wikimedia Commons, public domain (cropped) · Public domain (work of the U.S. federal government)

At a glance

Effective January 1, 2027, CMS removes HCPCS A4453 and A4459 from the home health consolidated billing non-routine supply code list. Sources below

CMS's annual consolidated billing update for 2027 removes two HCPCS codes from the home health non-routine supply list, effective January 1, 2027 (MM14639, PDF). The instruction to MACs is Change Request 14639, transmittal R13988CP, dated October 8, 2026, with an implementation date of January 4, 2027 (transmittal R13988CP, PDF). The article appeared in the October 15 MLN Connects.

The two codes

The transmittal's own descriptors, word for word:

  • A4453: "Rectal catheter with or without balloon, for use with any type transanal irrigation system, each"
  • A4459: "Manual Pump Enema System, Includes Balloon, Catheter And All Accessories, Reusable, Any Type"

No codes are added to the therapy code list this year; the transmittal says "No update."

Why the list matters

Consolidated billing is the rule that, while a patient is under a home health plan of care, Medicare pays the home health agency for the bundled services and supplies on these lists, and won't pay another provider or supplier separately for them. MM14639 lists the exceptions: therapies physicians perform, supplies incident to physician services, and supplies used in institutional settings. The transmittal tells MACs to remove A4453 and A4459 for claims with line-item dates of service on or after January 1, 2027. From that date, Medicare's consolidated billing edits stop treating the two codes as bundled.

What CMS doesn't say

The documents don't explain why these two codes specifically come off. The transmittal's standing explanation is that the annual list follows changes to the HCPCS code set, and that "no additional services will be added by these updates." We'll check the 2027 HCPCS annual file when it posts before saying more.

One housekeeping note from reading CMS's coding page: the downloadable Home Health Consolidated Billing Master Code List still shows "Updated 09/27/2024" (CMS home health coding and billing page). Billing teams who rely on that workbook should line it up against the 2027 transmittal.

What to watch

  • January 1, 2027: dates of service where the change applies.
  • January 4, 2027: MAC systems implementation.
  • Illinois home health agencies: Palmetto GBA (Jurisdiction M) is the home health and hospice MAC (our JM hub; CMS JM page).

Sources

Track every MAC change: our Medicare jurisdictions tracker lists CMS and MAC bulletins by jurisdiction, including Palmetto GBA, Jurisdiction M for Illinois.

It is general information, not clinical, billing or legal advice.*

Drafted with AI assistance from primary sources and reviewed by Monsaur Othman before publication. Read how we use AI, our editorial policy and our corrections policy.

Informational only, not billing, legal or clinical advice. Check the linked primary source and your Medicare Administrative Contractor.

Key facts and where they come from

  • Effective January 1, 2027, CMS removes HCPCS A4453 and A4459 from the home health consolidated billing non-routine supply code list. source 1 · source 2 · source 3
  • CR 14639 was released October 8, 2026, implementation January 4, 2027; MM14639 was released October 9, 2026. source 1
  • No codes are added to the therapy code list in this update. source 1
  • CMS says updates reflect changes to the HCPCS code set, not a redefinition of services subject to consolidated billing. source 1
  • CMS's master consolidated billing code list on its coding page shows an update date of 09/27/2024. source 1