Pessary Medicare Reimbursement Guide (HCPCS A4562) — 2026 Update

If you're considering a non-surgical pessary for pelvic organ prolapse or stress urinary incontinence, the question of cost — and whether your insurance will pay — usually comes up before the question of sizing. This guide walks through how Medicare reimburses a silicone vaginal pessary under the HCPCS code A4562, what private insurance typically covers, the HSA/FSA path, and when it's genuinely cheaper to pay $49.99 direct than to file a claim.

The short answer

Medicare Part B covers a silicone ring pessary (HCPCS code A4562) as a durable medical equipment (DME) item when a physician prescribes it for a covered diagnosis (typically pelvic organ prolapse — ICD-10 N81.0 through N81.9). Most private insurers follow Medicare's lead. You'll generally pay 20% of the Medicare-approved amount after meeting your Part B deductible.

But here is the math that surprises most patients: the Medicare-approved amount for A4562 in 2026 is approximately $69-$89 per device depending on locality. After your 20% coinsurance and the Part B deductible, your out-of-pocket cost is often higher than buying direct at $49.99 without any prescription paperwork. We explain when each path makes sense below.

What is HCPCS code A4562?

HCPCS Level II code A4562 is the billing code for a Pessary, non-rubber, any type. Modern vaginal pessaries are made from medical-grade silicone — a non-rubber material — so silicone devices such as the FDA 510(k)-cleared SciMed Silicone Ring Pessary With Support are billed under A4562. This is the correct HCPCS code for any silicone ring, Gellhorn, cube, donut, or dish-style pessary.

The older code A4561 is for a Pessary, rubber, any type — it applies only to legacy rubber/latex devices, which are rarely used today because of allergy and durability concerns. Because SciMed pessaries are 100% medical-grade silicone and latex-free, A4561 does not apply; the correct code is A4562. If a billing office has historically coded a silicone pessary under the rubber-only A4561, that should be updated to A4562. When in doubt, your prescribing provider's billing office can confirm the code with your Medicare Administrative Contractor (MAC).

Both A4561 and A4562 are listed on the Medicare DMEPOS fee schedule, which means the device is treated as durable medical equipment, not as part of an office-visit fee. The fitting itself is billed separately under CPT 57160 (fitting and insertion of pessary).

Medicare Part B coverage — the four conditions

To qualify for Medicare reimbursement under A4562, four conditions usually have to be met:

1. You're enrolled in Medicare Part B (Part A alone does not cover DME).
2. A Medicare-enrolled physician or qualified provider has documented a covered diagnosis — typically pelvic organ prolapse (N81.0–N81.9), genital prolapse, or stress urinary incontinence with a pelvic-floor indication.
3. The device is supplied by a Medicare-enrolled DME provider who has accepted assignment (most clinics use their preferred medical-supply distributor; some carry the device in-office).
4. You have met your Part B annual deductible ($240 in 2024; check current year). After the deductible, Medicare pays 80% of the approved amount and you pay 20%.

What you'll actually pay — the cost math

Below is a realistic 2026 cost comparison for a single ring pessary in the United States. We've used the Medicare DMEPOS fee schedule for A4562 (approximately $69 in most localities) and a typical private insurance plan with a $1,500 deductible:

For most patients who have already met their deductible, traditional Medicare comes out cheapest. For patients who have not met their deductible — which is the case for most people in the first half of the year — direct purchase from SciMed at $49.99 is typically the lowest out-of-pocket option.

The HSA / FSA path — simpler and often the same total cost

A vaginal pessary qualifies as a Section 213(d) medical expense under the Internal Revenue Code, which means you can pay for it with pre-tax HSA or FSA dollars. The mechanics:

• Pay with your HSA or FSA debit card at SciMed checkout. The transaction is coded as a medical-device purchase.
• Keep your SciMed receipt for IRS substantiation. The receipt shows the device, HCPCS reference, and price.
• If your HSA/FSA card was declined at checkout, pay with a regular card and submit the receipt for reimbursement from your HSA/FSA administrator.

For a patient in the 22% federal tax bracket, paying $49.99 with HSA/FSA dollars is the equivalent of paying about $39 post-tax. That math beats the Medicare path for patients who haven't met their deductible.

How to file a Medicare claim if you choose that path

If you decide to go the Medicare reimbursement route through a DME supplier:

1. Get a written prescription from your OB-GYN, urogynecologist, or primary care provider. The prescription must list the device type, size if known, ICD-10 diagnosis code, and the prescribing provider's NPI.
2. Choose a Medicare-enrolled DME supplier. Your clinic may have a preferred supplier; if not, search the Medicare.gov Care Compare tool for DME providers in your area.
3. The supplier handles the billing. You should pay only your 20% coinsurance plus any unmet deductible at the time of pickup.
4. Verify the claim was paid by checking your Medicare Summary Notice (MSN) about 3–4 weeks after the date of service.

If you're enrolled in a Medicare Advantage plan, the rules vary by plan. Some Medicare Advantage plans cover pessaries with no co-pay; others have a $30–$80 co-pay or require pre-authorization. Call the customer service line on the back of your Advantage card before purchasing.

Private insurance — what to ask before you buy

Private insurance reimbursement varies enormously. Before you assume a covered claim, call your insurer and ask three specific questions:

1. "Does my plan cover HCPCS code A4562 — a silicone ring pessary — as durable medical equipment?"
2. "What is my cost share after my deductible is met? Co-insurance percentage, or a flat co-pay?"
3. "Do I need to use an in-network DME supplier, and can the supplier file the claim directly?"

If the answers add up to a covered claim with a low co-pay and you don't mind the 2–6 week wait, file the insurance claim. If the answers add up to high deductibles, out-of-network supplier requirements, or pre-authorization paperwork, paying $49.99 direct at SciMed is often the path with less friction.

When direct purchase makes the most sense

From the patient questions we receive at SciMed every week, here are the scenarios where direct purchase consistently beats the insurance path:

• You're between sizes and need to try two or three sizes to find the right fit. A 3-size right-size pack at $119.99 is far cheaper than 3 separate insurance claims.
• You haven't met your annual deductible and likely won't meet it.
• You have a high-deductible health plan with HSA. Pay direct with the HSA card, keep the receipt, get the tax benefit.
• Your insurance requires a $200–$400 in-office fitting visit before they'll pay for the device itself.
• You already know your size from a previous pessary and just need a fresh device every 1–2 years.
• You want a backup device in addition to the one your clinic prescribed.

The bottom line

HCPCS code A4562 is covered by Medicare and most major private insurers, but the practical out-of-pocket cost — once you factor in deductibles, in-network supplier requirements, and processing delays — is often higher than the $49.99 direct price at SciMed. For patients with a met deductible and a clinic-supplied device, Medicare is the cheapest path. For everyone else (which is most patients early in the calendar year), direct purchase with an HSA/FSA card is the fastest and frequently the lowest-cost option.

If you're unsure which path is right for you, email our team at sales@scimedstore.com. We can send a sample receipt for HSA/FSA pre-approval, or walk you through whether your insurance is likely to cover the device. Same-business-day response.

Related reading

• Vaginal Pessary Size Guide
• Ring Pessary Side Effects — Normal vs Call Your Doctor
• Pessary Stuck? Safe At-Home Removal
• Vaginal Pessary Cost Guide — 2026

Medical disclaimer: This article is for educational purposes and does not constitute medical or financial advice. Confirm all coverage details with your insurance carrier and clinical recommendations with your healthcare provider. SciMed Store is not a Medicare-enrolled DME supplier; direct purchases from SciMed are not eligible for traditional Medicare reimbursement (they are eligible for HSA/FSA reimbursement under Section 213(d)). Reviewed by the SciMed clinical support team, 2026-06-21.