## **What is HCPCS code A4456?**
HCPCS A4456, which has a full description of “Adhesive remover, wipes, any type, each,” designates a single-use adhesive remover wipe applicable to all types of adhesive residues, such as those from medical tapes, ostomy appliances, dressings, films, extended wear products, and cement-like adhesives.
This code, which falls under surgical dressings and medical supplies, is most often used in the context of ostomy care (colostomy, ileostomy, urostomy). Adhesive remover wipes support procedures involving an ostomy pouch by safely loosening adhesive barriers without damaging the skin. They are particularly important for patients using extended wear pouches or barriers, where adhesives may be more resistant.
## **HCPCS code A4456 documentation requirements**
For reimbursement, ensure documentation reflects:
- **Standard Written Order (SWO)**: A complete, signed, and dated order from the treating practitioner (physician or other healthcare professional) must be on file before the claim is submitted. The order should include the patient's name, a description of the item, and the quantity to dispense.
- **Medical necessit**y: The patient's medical record must clearly demonstrate that the patient has a surgically created opening (stoma) to divert urine or fecal contents (colostomy, ileostomy, or urostomy) that requires the use of adhesive remover wipes.
- **Proof of Delivery (POD)**: The supplier must maintain documentation that confirms the date the supplies were delivered to the beneficiary. This can be a signed delivery slip or a commercial carrier's tracking slip, prepared contemporaneously with the delivery.
- **Continued medical need**: For refills, the supplier must contact the beneficiary or caregiver to confirm the need for a refill and document the affirmative request before dispensing the new supply.
## **A4456 billing requirements**
Billing for A4456 is governed by Durable Medical Equipment Medicare Administrative Contractor (DME MAC) policies, which often specify quantity limits.
- **Unit of service**: Bill the code using the unit of service "each." For example, if 50 wipes are dispensed, the quantity billed should be 50 units of A4456.
- **Maximum quantity**: Note that national and regional policies often set a usual maximum quantity. For A4456, Medicare policies generally allow up to 50 wipes per month. If a patient requires a quantity exceeding this limit, the medical record must contain specific documentation explaining the medical reason for the increased amount.
- **Refills**: Suppliers should not automatically ship refills. Refill contact should occur no sooner than 30 calendar days prior to the expected end of the current supply, and delivery should be no sooner than 10 calendar days prior to the expected exhaustion date.
- **Setting**: For a beneficiary at home, supplies are typically limited to a three-month supply. Meanwhile, for a beneficiary in a nursing facility, supplies are limited to a one-month supply.
- **Modifiers**: Specific modifiers may be required for certain payers or situations when billed with other ostomy supplies like tape or adhesive.
## **Other relevant codes**
- **A4455**: Adhesive remover or solvent (for tape, cement, or other adhesive), per ounce
- **A4364**: Adhesive, liquid or equal, any type, per oz
- **A4450**: Tape, non-waterproof, per 18 square inches
- **A4452**: Tape, waterproof, per 18 square inches
- **A5120**: Skin barrier, wipes or swabs, each
- **A4406**: Ostomy skin barrier, pectin-based, paste, per oz
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