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.


  • A2011

    Supra sdrm, per square centimeter
  • A2012

    Suprathel, per square centimeter
  • A2013

    Innovamatrix fs, per square centimeter
  • A2014

    Omeza collagen matrix, per 100 mg
  • A2015

    Phoenix wound matrix, per square centimeter
  • A2016

    Permeaderm b, per square centimeter
  • A2017

    Permeaderm glove, each
  • A2018

    Permeaderm c, per square centimeter
  • A2019

    Kerecis omega3 marigen shield, per square centimeter
  • A2020

    Ac5 advanced wound system (ac5)


  • Continued
  • A2021

    Neomatrix, per square centimeter
  • A2022

    Innovaburn or innovamatrix xl, per square centimeter
  • A2023

    Innovamatrix pd, 1 mg
  • A2024

    Resolve matrix, per square centimeter
  • A2025

    Miro3d, per cubic centimeter
  • A4100

    Skin substitute, fda cleared as a device, not otherwise specified
  • A4206

    Syringe with needle, sterile, 1 cc or less, each
  • A4207

    Syringe with needle, sterile 2 cc, each
  • A4208

    Syringe with needle, sterile 3 cc, each
  • A4209

    Syringe with needle, sterile 5 cc or greater, each
  • A4210

    Needle-free injection device, each
  • A4211

    Supplies for self-administered injections
  • A4212

    Non-coring needle or stylet with or without catheter
  • A4213

    Syringe, sterile, 20 cc or greater, each
  • A4215

    Needle, sterile, any size, each
  • 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)


  • Continued
  • 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)