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HCPCS A4259 · Level II · A code

A4259: Lancets, per box of 100, 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 A4259

Medicare payment
$1.42
DMEPOS non-rural state fees
Coverage code
D
special coverage instructions apply
DME supplier MUE
1
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

HCPCS Level II A4259 reads "Lancets, per box of 100" in the October 2026 file; it dates from 1985. The October 2026 DMEPOS fee schedule (category SU, supplies) sets A4259 at $1.42 in every contiguous state. CMS caps A4259 at practitioner 0 (MAI 3, CMS Policy); hospital outpatient 0 (MAI 3, CMS Policy); DME supplier 1 (MAI 3, Nature of Equipment) units per day in the 2026 Q4 MUE tables. 1 active LCD lists A4259: L33822 (Glucose Monitors). 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: A4258, A4253, A4239, A4238.

A4259 descriptor and code status

The October 2026 HCPCS Level II file describes A4259 as “Lancets, per box of 100”. 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 "A4259 CPT code", A4259 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 A4259
FieldValue
Short descriptorLancets per box
Added to HCPCS1985-01-01
Last actionN (no maintenance), effective 1996-01-01
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 A4259

The October 2026 DMEPOS fee schedule (category SU, supplies) sets A4259 at $1.42 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 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).

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 A4259 by modifier
ModifierFloor / ceilingNon-rural state rangeRural rangeAK / HI / PR / VI
none—$1.42 (49 states)—AK $1.42, HI $1.42, PR $1.42, VI $1.42

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 A4259

CMS caps A4259 at practitioner 0 (MAI 3, CMS Policy); hospital outpatient 0 (MAI 3, CMS Policy); DME supplier 1 (MAI 3, Nature of Equipment) 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 A4259 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services03 Date of Service Edit: ClinicalCMS Policy
Facility outpatient hospital03 Date of Service Edit: ClinicalCMS Policy
DME supplier13 Date of Service Edit: ClinicalNature of Equipment

The MUE lookup for A4259 shows every setting next to any other code on the same claim.

NCCI edits and add-on rules

No active practitioner PTP pair lists A4259 in v323r0.

A4259 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 A4259 against a second code to see whether the pair bundles and whether a modifier can separate the services.

Medicare coverage policies for A4259

1 active Local Coverage Determination and 0 billing and coding articles list A4259. 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 A4259

CARC 50 · N115

the diagnosis or documentation does not meet the LCD or billing article that lists A4259

CARC 151 · N362

units of A4259 exceed the DME supplier MUE of 1 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 A4259 claims

QuickAuth coordinates the requirement checks and documentation that DME claims for A4259 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 A4259

What does HCPCS code A4259 describe?

"Lancets, per box of 100" (short descriptor "Lancets per box"), in the A section (transportation, medical and surgical supplies, administrative, miscellaneous and investigational). Added 1985-01-01; last action N (no maintenance) effective 1996-01-01.

Is A4259 a CPT code?

It is not. A4259 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. "A4259 CPT code" searches refer to it.

What does Medicare pay for A4259?

The October 2026 DMEPOS fee schedule (category SU, supplies) sets A4259 at $1.42 in every contiguous state.

How many units of A4259 can be billed per day?

CMS caps A4259 at practitioner 0 (MAI 3, CMS Policy); hospital outpatient 0 (MAI 3, CMS Policy); DME supplier 1 (MAI 3, Nature of Equipment) units per day in the 2026 Q4 MUE tables. For the DME supplier 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 A4259?

Coverage code D (special coverage instructions apply). 1 active LCD lists A4259: 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.