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   New
  • A2015

    Phoenix wound matrix, per square centimeter   New
  • A2016

    Permeaderm b, per square centimeter   New
  • A2017

    Permeaderm glove, each   New
  • A2018

    Permeaderm c, per square centimeter   New
  • A4100

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

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


  • Continued
  • 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)
  • 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


  • Continued
  • 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 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