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HCPCS A4225 · Level II · A code

A4225: Supplies for external insulin infusion pump, syringe type cartridge, sterile, each, 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); DMEPOS fee schedule: DME26-D (October 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 DMEPOS fee schedule 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 A4225

Medicare payment
$3.47
DMEPOS non-rural state fees
Coverage code
D
special coverage instructions apply
Practitioner MUE
0
MAI 3
OPPS status
SI N
Items and Services packaged into APC rates
NCCI PTP pairs
0
practitioner file
LCDs and articles
1 / 0

TL;DR

A4225 is a Level II code from the A section (transportation, medical and surgical supplies, administrative, miscellaneous and investigational), in use since 2017: "Supplies for external insulin infusion pump, syringe type cartridge, sterile, each". A4225 is paid from the DMEPOS fee schedule as supplies (SU): $3.47 in every contiguous state, rural $3.60 to $3.62, October 2026. MUE limits for A4225: practitioner 0 (MAI 3, CMS Policy); hospital outpatient 1 (MAI 3, Nature of Equipment). 1 active LCD lists A4225: L33794 (External Infusion Pumps). OPPS status indicator N: Items and Services packaged into APC rates. HCPCS record: BETOS D1E (other DME); pricing indicator 34; type of service P (lump-sum purchase of DME, prosthetics or orthotics). Nearby codes: A4224, A4222, A4221, A4220.

A4225 descriptor and code status

The October 2026 HCPCS Level II file describes A4225 as “Supplies for external insulin infusion pump, syringe type cartridge, sterile, each”. 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 A4225
FieldValue
Short descriptorSup/ext insulin inf pump syr
Added to HCPCS2017-01-01
Last actionN (no maintenance), effective 2017-01-01
Coverage codeD: special coverage instructions apply
Pricing indicator34: DMEPOS DME supplies (floors and ceilings)
BETOS categoryD1E: other DME
Type of serviceP: lump-sum purchase of DME, prosthetics or orthotics

Medicare payment for A4225

A4225 is paid from the DMEPOS fee schedule as supplies (SU): $3.47 in every contiguous state, rural $3.60 to $3.62, October 2026. 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 X: statutory exclusion: not a physician service under the fee schedule. Global period XXX (global surgery concept does not apply); PC/TC indicator 9 (professional/technical concept does not apply).

DMEPOS fee schedule (DME26-D)

Jurisdiction D (DME MAC), payment category SU (supplies). Fees are set per state; AK, HI, PR and VI are not subject to the national ceiling and floor and are listed separately. A rural fee applies only in ZIP codes on the CMS rural ZIP list.

DMEPOS fees for A4225 by modifier
ModifierFloor / ceilingNon-rural state rangeRural rangeAK / HI / PR / VI
none—$3.47 (49 states)$3.60 (AZ, CA, DC…) to $3.62 (AL, AR, CO…)AK $3.60, HI $3.60, PR $3.96, VI $3.62

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 A4225

MUE limits for A4225: practitioner 0 (MAI 3, CMS Policy); hospital outpatient 1 (MAI 3, Nature of Equipment). 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 A4225 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services03 Date of Service Edit: ClinicalCMS Policy
Facility outpatient hospital13 Date of Service Edit: ClinicalNature of Equipment

The MUE lookup for A4225 shows every setting next to any other code on the same claim.

NCCI edits and add-on rules

No active practitioner PTP pair lists A4225 in v323r0.

A4225 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 A4225 against a second code to see whether the pair bundles and whether a modifier can separate the services.

Medicare coverage policies for A4225

1 active Local Coverage Determination and 0 billing and coding articles list A4225. Each applies only in its contractor's jurisdiction, and the article carries the diagnosis codes that support the item or service.

Denials to expect on A4225

CARC 50 · N115

the diagnosis or documentation does not meet the LCD or billing article that lists A4225

CARC 151 · N362

units of A4225 exceed the practitioner MUE of 0 per date of service

CARC 4

the modifier reported is inconsistent with the code

CARC 16

the claim lacks information needed to adjudicate the line, such as an order, NPI or required modifier

Where QuickIntell fits for A4225 claims

QuickAuth coordinates the requirement checks and documentation that DME claims for A4225 depend on, with human review of each case, and QuickRCM carries claim readiness and the CARC 50, 151 and modifier denials these items draw.

See QuickAuth for requirement checksSee QuickRCM for denial follow-upBook a meeting

Frequently asked questions: HCPCS A4225

What does HCPCS code A4225 describe?

"Supplies for external insulin infusion pump, syringe type cartridge, sterile, each" (short descriptor "Sup/ext insulin inf pump syr"), in the A section (transportation, medical and surgical supplies, administrative, miscellaneous and investigational). Added 2017-01-01.

Is A4225 a CPT code?

No: CMS maintains A4225 in HCPCS Level II, while the AMA maintains CPT. It goes in the same procedure-code field.

What does Medicare pay for A4225?

A4225 is paid from the DMEPOS fee schedule as supplies (SU): $3.47 in every contiguous state, rural $3.60 to $3.62, October 2026.

How many units of A4225 can be billed per day?

MUE limits for A4225: practitioner 0 (MAI 3, CMS Policy); hospital outpatient 1 (MAI 3, Nature of Equipment). For the practitioner MUE (MAI 3), units above 0 deny for the day but can be paid on appeal with documentation; denials arrive as CARC 151.

Does Medicare cover A4225?

Coverage code D (special coverage instructions apply). 1 active LCD lists A4225: L33794 (External Infusion Pumps).

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.