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HCPCS A4238 · Level II · A code

A4238: Supply allowance for adjunctive, non-implanted continuous glucose monitor (CGM), 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 A4238

Medicare payment
$280.71
DMEPOS non-rural state fees (KF)
Coverage code
C
carrier judgment, so the Medicare contractor decides coverage
DME supplier MUE
3
MAI 3
OPPS status
SI Y
Non-implantable DME
NCCI PTP pairs
0
practitioner file
LCDs and articles
1 / 0

TL;DR

HCPCS Level II A4238 reads "Supply allowance for adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service" in the October 2026 file; it dates from 2022. The October 2026 DMEPOS fee schedule (category SU, supplies) sets A4238 at KF (FDA class III device) $280.71 in every contiguous state. CMS caps A4238 at practitioner 3 (MAI 3, CMS Policy); hospital outpatient 3 (MAI 3, CMS Policy); DME supplier 3 (MAI 3, CMS Policy) units per day in the 2026 Q4 MUE tables. 1 active LCD lists A4238: L33822 (Glucose Monitors). OPPS status indicator Y: Non-implantable DME. HCPCS record: BETOS D1E (other DME); pricing indicator 34; type of service 9 (other medical items or services). Nearby codes: A4239, A4225, A4224, A4253.

A4238 descriptor and code status

The October 2026 HCPCS Level II file describes A4238 as “Supply allowance for adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service”. It sits in the A section (transportation, medical and surgical supplies, administrative, miscellaneous and investigational), listed with the other A codes. Although searches often call it the "A4238 CPT code", A4238 is a HCPCS Level II code maintained by CMS, not an AMA CPT code; both go in the same procedure-code field on the claim.

HCPCS file attributes of A4238
FieldValue
Short descriptorAdju cgm supply allowance
Added to HCPCS2022-04-01
Last actionN (no maintenance), effective 2023-01-01
Coverage codeC: carrier judgment, so the Medicare contractor decides coverage
Pricing indicator34: DMEPOS DME supplies (floors and ceilings)
BETOS categoryD1E: other DME
Type of service9: other medical items or services

Medicare payment for A4238

The October 2026 DMEPOS fee schedule (category SU, supplies) sets A4238 at KF (FDA class III device) $280.71 in every contiguous state. 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 A4238 by modifier
ModifierFloor / ceilingNon-rural state rangeRural rangeAK / HI / PR / VI
KF (FDA class III device)—$280.71 (49 states)—AK $280.71, HI $280.71, PR $280.71, VI $280.71

Hospital outpatient (OPPS Addendum B)

Status indicator Y (Non-implantable DME), with no separate OPPS payment rate.

Medically Unlikely Edits for A4238

CMS caps A4238 at practitioner 3 (MAI 3, CMS Policy); hospital outpatient 3 (MAI 3, CMS Policy); DME supplier 3 (MAI 3, CMS Policy) units per day in the 2026 Q4 MUE tables. The DME supplier MUE is a date-of-service clinical edit: units above the limit deny but can be paid on appeal with documentation.

MUE values for A4238 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services33 Date of Service Edit: ClinicalCMS Policy
Facility outpatient hospital33 Date of Service Edit: ClinicalCMS Policy
DME supplier33 Date of Service Edit: ClinicalCMS Policy

The MUE lookup for A4238 shows every setting next to any other code on the same claim.

NCCI edits and add-on rules

No active practitioner PTP pair lists A4238 in v323r0.

A4238 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 A4238 against a second code to see whether the pair bundles and whether a modifier can separate the services.

Medicare coverage policies for A4238

1 active Local Coverage Determination and 0 billing and coding articles list A4238. 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 A4238

CARC 50 · N115

the diagnosis or documentation does not meet the LCD or billing article that lists A4238

CARC 151 · N362

units of A4238 exceed the DME supplier MUE of 3 per date of service

CARC 4

the KF payment modifier is missing or does not match the item

CARC 16

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

Where QuickIntell fits for A4238 claims

QuickAuth coordinates the requirement checks and documentation that DME claims for A4238 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 A4238

What does HCPCS code A4238 describe?

"Supply allowance for adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service" (short descriptor "Adju cgm supply allowance"), in the A section (transportation, medical and surgical supplies, administrative, miscellaneous and investigational). Added 2022-04-01; last action N (no maintenance) effective 2023-01-01.

Is A4238 a CPT code?

It is not. A4238 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. "A4238 CPT code" searches refer to it.

What does Medicare pay for A4238?

The October 2026 DMEPOS fee schedule (category SU, supplies) sets A4238 at KF (FDA class III device) $280.71 in every contiguous state.

How many units of A4238 can be billed per day?

CMS caps A4238 at practitioner 3 (MAI 3, CMS Policy); hospital outpatient 3 (MAI 3, CMS Policy); DME supplier 3 (MAI 3, CMS Policy) units per day in the 2026 Q4 MUE tables. For the DME supplier MUE (MAI 3), units above 3 deny for the day but can be paid on appeal with documentation; denials arrive as CARC 151.

Does Medicare cover A4238?

Coverage code C (carrier judgment, so the Medicare contractor decides coverage). 1 active LCD lists A4238: L33822 (Glucose Monitors).

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.