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.

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• 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

• A4226

  Supplies for maintenance of insulin infusion pump with dosage rate adjustment using therapeutic continuous glucose sensing, per week

• 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

• A4238

  Supply allowance for adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service

• A4239

  Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service

• 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

• A4271

  Integrated lancing and blood sample testing cartridges for home blood glucose monitor, per 50 tests

• 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

• A4288

  Valve for breast pump, replacement

• A4290

  Sacral nerve stimulation test lead, each

• A4295

  Intermittent urinary catheter; straight tip, hydrophilic coating, each

• A4296

  Intermittent urinary catheter; coude (curved) tip, hydrophilic coating, each

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HCPCS Level II codes and descriptors are approved and maintained jointly by the alpha-numeric editorial panel (consisting of CMS, the Health Insurance Association of America, and the Blue Cross and Blue Shield Association). — Updated 7/24/2026

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