HCPCS A-Codes
Transportation Services Including Ambulance, Medical & Surgical Supplies

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.

• 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

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  Continued

• 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

• 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

• 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

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  Continued

• 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