This section covers a wide variety of medical and surgical supplies, as well as some DME-related supplies and accessories. Medicare generally covers DME-related supplies, accessories, maintenance, and repair under the prosthetic devices provision.


  • A4216

    Sterile water, saline and/or dextrose, diluent/flush, 10 ml
  • A4217

    Sterile water/saline, 500 ml
  • A4218

    Sterile saline or water, metered dose dispenser, 10 ml
  • A4220

    Refill kit for implantable infusion pump
  • A4221

    Supplies for maintenance of non-insulin drug infusion catheter, per week (list drugs separately)
  • A4222

    Infusion supplies for external drug infusion pump, per cassette or bag (list drugs separately)
  • A4223

    Infusion supplies not used with external infusion pump, per cassette or bag (list drugs separately)
  • A4224

    Supplies for maintenance of insulin infusion catheter, per week
  • A4225

    Supplies for external insulin infusion pump, syringe type cartridge, sterile, each
  • A4230

    Infusion set for external insulin pump, non needle cannula type
  • A4231

    Infusion set for external insulin pump, needle type
  • A4232

    Syringe with needle for external insulin pump, sterile, 3 cc
  • A4233

    Replacement battery, alkaline (other than j cell), for use with medically necessary home blood glucose monitor owned by patient, each
  • A4234

    Replacement battery, alkaline, j cell, for use with medically necessary home blood glucose monitor owned by patient, each
  • A4235

    Replacement battery, lithium, for use with medically necessary home blood glucose monitor owned by patient, each
  • A4236

    Replacement battery, silver oxide, for use with medically necessary home blood glucose monitor owned by patient, each
  • A4244

    Alcohol or peroxide, per pint
  • A4245

    Alcohol wipes, per box
  • A4246

    Betadine or phisohex solution, per pint
  • A4247

    Betadine or iodine swabs/wipes, per box
  • A4248

    Chlorhexidine containing antiseptic, 1 ml
  • A4250

    Urine test or reagent strips or tablets (100 tablets or strips)
  • A4252

    Blood ketone test or reagent strip, each
  • A4253

    Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips
  • A4255

    Platforms for home blood glucose monitor, 50 per box
  • A4256

    Normal, low and high calibrator solution / chips
  • A4257

    Replacement lens shield cartridge for use with laser skin piercing device, each
  • A4258

    Spring-powered device for lancet, each
  • A4259

    Lancets, per box of 100
  • A4261

    Cervical cap for contraceptive use
  • A4262

    Temporary, absorbable lacrimal duct implant, each
  • A4263

    Permanent, long term, non-dissolvable lacrimal duct implant, each
  • A4264

    Permanent implantable contraceptive intratubal occlusion device(s) and delivery system
  • A4265

    Paraffin, per pound
  • A4266

    Diaphragm for contraceptive use
  • A4267

    Contraceptive supply, condom, male, each
  • A4268

    Contraceptive supply, condom, female, each
  • A4269

    Contraceptive supply, spermicide (e.g., foam, gel), each
  • A4270

    Disposable endoscope sheath, each
  • A4280

    Adhesive skin support attachment for use with external breast prosthesis, each
  • A4281

    Tubing for breast pump, replacement
  • A4282

    Adapter for breast pump, replacement
  • A4283

    Cap for breast pump bottle, replacement
  • A4284

    Breast shield and splash protector for use with breast pump, replacement
  • A4285

    Polycarbonate bottle for use with breast pump, replacement
  • A4286

    Locking ring for breast pump, replacement
  • A4290

    Sacral nerve stimulation test lead, each
  • A4300

    Implantable access catheter, (e.g., venous, arterial, epidural subarachnoid, or peritoneal, etc.) external access
  • A4301

    Implantable access total catheter, port/reservoir (e.g., venous, arterial, epidural, subarachnoid, peritoneal, etc.)
  • A4305

    Disposable drug delivery system, flow rate of 50 ml or greater per hour