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.


  • 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


  • Continued
  • 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
  • A4287

    Disposable collection and storage bag for breast milk, any size, any type, each   New
  • 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
  • A4306

    Disposable drug delivery system, flow rate of less than 50 ml per hour


  • Continued
  • A4310

    Insertion tray without drainage bag and without catheter (accessories only)
  • A4311

    Insertion tray without drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.)
  • A4312

    Insertion tray without drainage bag with indwelling catheter, foley type, two-way, all silicone
  • A4313

    Insertion tray without drainage bag with indwelling catheter, foley type, three-way, for continuous irrigation
  • A4314

    Insertion tray with drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.)
  • A4315

    Insertion tray with drainage bag with indwelling catheter, foley type, two-way, all silicone
  • A4316

    Insertion tray with drainage bag with indwelling catheter, foley type, three-way, for continuous irrigation
  • A4320

    Irrigation tray with bulb or piston syringe, any purpose
  • A4321

    Therapeutic agent for urinary catheter irrigation
  • A4322

    Irrigation syringe, bulb or piston, each
  • A4326

    Male external catheter with integral collection chamber, any type, each
  • A4327

    Female external urinary collection device; meatal cup, each
  • A4328

    Female external urinary collection device; pouch, each
  • A4330

    Perianal fecal collection pouch with adhesive, each
  • A4331

    Extension drainage tubing, any type, any length, with connector/adaptor, for use with urinary leg bag or urostomy pouch, each
  • A4332

    Lubricant, individual sterile packet, each
  • A4333

    Urinary catheter anchoring device, adhesive skin attachment, each
  • A4334

    Urinary catheter anchoring device, leg strap, each
  • A4335

    Incontinence supply; miscellaneous
  • A4336

    Incontinence supply, urethral insert, any type, each