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HCPCS A4220 · Level II · A code

A4220: Refill kit for implantable infusion pump, HCPCS Level II A code

Compiled from CMS files by the QuickIntell RCM Editorial Team · Data effective · Method: reference methodology · Report a data correction

Data currency: HCPCS Level II file: October 2026 (effective October 1, 2026); PFS relative value file: RVU26D, released August 26, 2026 (effective October 1, 2026); NCCI MUE tables: 2026 Q4 (effective October 1, 2026); NCCI PTP edits: v323r0 (2026 Q4) (effective October 1, 2026); OPPS Addendum B: October 2026 (effective October 1, 2026); Medicare Coverage Database LCD export: MCD release October 8, 2026 (effective October 4, 2026). Next CMS release: January 1, 2027 (quarterly update) for the HCPCS Level II file and NCCI MUE tables and NCCI PTP edits and OPPS Addendum B; RVU27A with the CY2027 PFS final rule, effective January 1, 2027 for the PFS relative value file; weekly, every Thursday for the Medicare Coverage Database LCD export.

Key facts for A4220

Medicare payment
no PFS amount
PFS status P
Coverage code
D
special coverage instructions apply
Practitioner MUE
1
MAI 3
OPPS status
SI N
Items and Services packaged into APC rates
NCCI PTP pairs
4
4 hospital outpatient
LCDs and articles
1 / 1

TL;DR

HCPCS Level II A4220 reads "Refill kit for implantable infusion pump" in the October 2026 file; it dates from 1994. The physician fee schedule lists A4220 with status P (bundled or excluded: no separate physician fee schedule payment), so the PFS carries no national amount for it. CMS caps A4220 at practitioner 1 (MAI 3, Clinical: Data); hospital outpatient 1 (MAI 3, Clinical: Data) units per day in the 2026 Q4 MUE tables. In the NCCI PTP files v323r0 A4220 appears in 4 practitioner pairs as column 2 and 0 as column 1 (most often with 62369, 62370, 95990), and in 4 hospital outpatient pairs as column 2 and 0 as column 1. 1 active LCD and 1 billing and coding article list A4220 across 7 states: L33461 (Implantable Infusion Pump), A56695. OPPS status indicator N: Items and Services packaged into APC rates. HCPCS record: BETOS D1A (medical/surgical supplies); pricing indicator 57; type of service P (lump-sum purchase of DME, prosthetics or orthotics). Nearby codes: A4221, A4222, A4217, A4216.

A4220 descriptor and code status

The October 2026 HCPCS Level II file describes A4220 as “Refill kit for implantable infusion pump”. It sits in the A section (transportation, medical and surgical supplies, administrative, miscellaneous and investigational), listed with the other A codes.

HCPCS file attributes of A4220
FieldValue
Short descriptorInfusion pump refill kit
Added to HCPCS1994-01-01
Last actionN (no maintenance), effective 1998-03-03
Coverage codeD: special coverage instructions apply
Pricing indicator57: other contractor-priced
BETOS categoryD1A: medical/surgical supplies
Type of serviceP: lump-sum purchase of DME, prosthetics or orthotics

Medicare payment for A4220

The physician fee schedule lists A4220 with status P (bundled or excluded: no separate physician fee schedule payment), so the PFS carries no national amount for it. The amounts below are national figures from the October 2026 CMS files; the contractor applies the locality, rural or state adjustment and the beneficiary's cost sharing.

Physician fee schedule (RVU26D)

Status P: bundled or excluded: no separate physician fee schedule payment. Global period XXX (global surgery concept does not apply); PC/TC indicator 9 (professional/technical concept does not apply).

Hospital outpatient (OPPS Addendum B)

Status indicator N (Items and Services packaged into APC rates), with no separate OPPS payment rate.

Medically Unlikely Edits for A4220

CMS caps A4220 at practitioner 1 (MAI 3, Clinical: Data); hospital outpatient 1 (MAI 3, Clinical: Data) units per day in the 2026 Q4 MUE tables. The practitioner MUE is a date-of-service clinical edit: units above the limit deny but can be paid on appeal with documentation.

MUE values for A4220 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services13 Date of Service Edit: ClinicalClinical: Data
Facility outpatient hospital13 Date of Service Edit: ClinicalClinical: Data

The MUE lookup for A4220 shows every setting next to any other code on the same claim.

NCCI edits and add-on rules

In the practitioner PTP file v323r0, A4220 is the column-2 (bundled) code in 4 active pairs, 0% of which allow a modifier and the column-1 code in 0; 0 earlier pairs have been deleted. CMS's most frequent rationale for the bundled pairs: Misuse of Column Two code with Column One code.

Column-1 codes most often paired with A4220 (practitioner)
Column-1 codePairs
62369 (CPT; descriptor licensed by AMA)1
62370 (CPT; descriptor licensed by AMA)1
95990 (CPT; descriptor licensed by AMA)1
95991 (CPT; descriptor licensed by AMA)1

In the hospital outpatient PTP file v323r0, A4220 is the column-2 (bundled) code in 4 active pairs, 0% of which allow a modifier and the column-1 code in 0; 0 earlier pairs have been deleted. CMS's most frequent rationale for the bundled pairs: Misuse of Column Two code with Column One code.

Column-1 codes most often paired with A4220 (hospital outpatient)
Column-1 codePairs
62369 (CPT; descriptor licensed by AMA)1
62370 (CPT; descriptor licensed by AMA)1
95990 (CPT; descriptor licensed by AMA)1
95991 (CPT; descriptor licensed by AMA)1

A4220 is neither an add-on code nor a designated primary code in the 2026 Q4 NCCI add-on edit file.

Pair counts show exposure, not the answer for one claim. Check A4220 against a second code to see whether the pair bundles and whether a modifier can separate the services.

Medicare coverage policies for A4220

1 active Local Coverage Determination and 1 billing and coding article list A4220. Each applies only in its contractor's jurisdiction, and the article carries the diagnosis codes that support the item or service.

Billing and Coding Articles listing A4220
ArticleTitleContractor(s)Related LCD
A56695Billing and Coding: Implantable Infusion PumpPalmetto GBAL33461

Denials to expect on A4220

CARC 50 · N115

the diagnosis or documentation does not meet the LCD or billing article that lists A4220

CARC 151 · N362

units of A4220 exceed the practitioner MUE of 1 per date of service

CARC 4

the modifier reported is inconsistent with the code

CARC 16

the claim lacks the description, invoice or pricing detail a contractor-priced code needs

Where QuickIntell fits for A4220 claims

QuickCode supports qualified coder review of units, modifiers and NCCI pairs for A4220 before the claim leaves, and QuickRCM carries claim readiness and the denial follow-up when an edit or coverage policy is missed.

See QuickCode for coder reviewSee QuickRCM for denial follow-upBook a meeting

Frequently asked questions: HCPCS A4220

What does HCPCS code A4220 describe?

"Refill kit for implantable infusion pump" (short descriptor "Infusion pump refill kit"), in the A section (transportation, medical and surgical supplies, administrative, miscellaneous and investigational). Added 1994-01-01; last action N (no maintenance) effective 1998-03-03.

Is A4220 a CPT code?

It is not. A4220 belongs to the A section (transportation, medical and surgical supplies, administrative, miscellaneous and investigational) of HCPCS Level II, the CMS code set, not to AMA CPT.

What does Medicare pay for A4220?

The physician fee schedule lists A4220 with status P (bundled or excluded: no separate physician fee schedule payment), so the PFS carries no national amount for it.

How many units of A4220 can be billed per day?

CMS caps A4220 at practitioner 1 (MAI 3, Clinical: Data); hospital outpatient 1 (MAI 3, Clinical: Data) units per day in the 2026 Q4 MUE tables. For the practitioner MUE (MAI 3), units above 1 deny for the day but can be paid on appeal with documentation; denials arrive as CARC 151.

Does Medicare cover A4220?

Coverage code D (special coverage instructions apply). 1 active LCD and 1 billing and coding article list A4220 across 7 states: L33461 (Implantable Infusion Pump), A56695.

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-10. Verify against the primary file before billing or contracting decisions. The reference methodology explains how each figure is computed from these files.

Disclaimer

This page is an operational reference compiled from CMS publications: the HCPCS Level II file, the physician, DMEPOS and clinical laboratory fee schedules, OPPS and ASC addenda, NCCI MUE, PTP and add-on edit tables and the Medicare Coverage Database. Amounts are Medicare national figures before locality and state adjustment; Medicaid and commercial payers set their own. CPT codes are shown as numbers only; CPT descriptors are copyright AMA. Nothing here is legal, clinical or billing advice.

Found a figure that does not match the CMS file? Report a data correction with the CMS file and the value you expected; the request reaches the editorial team through the contact form.