HCPCS Codes for Lump sum purchase of DME, prosthetics, orthotics


  • 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
  • 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
  • A4280

    Adhesive skin support attachment for use with external breast prosthesis, each
  • 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
  • A4337

    Incontinence supply, rectal insert, any type, each
  • A4338

    Indwelling catheter; foley type, two-way latex with coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each
  • A4340

    Indwelling catheter; specialty type, (e.g., coude, mushroom, wing, etc.), each
  • A4344

    Indwelling catheter, foley type, two-way, all silicone, each
  • A4346

    Indwelling catheter; foley type, three way for continuous irrigation, each
  • A4349

    Male external catheter, with or without adhesive, disposable, each
  • A4351

    Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each
  • A4352

    Intermittent urinary catheter; coude (curved) tip, with or without coating (teflon, silicone, silicone elastomeric, or hydrophilic, etc.), each
  • A4353

    Intermittent urinary catheter, with insertion supplies