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A4239 Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service
BackA4100Non-sheet form skin substitute, fda cleared as a device, not otherwise specified (list in addition to primary procedure)→A4206Syringe with needle, sterile, 1 cc or less, each→A4207Syringe with needle, sterile 2 cc, each→A4208Syringe with needle, sterile 3 cc, each→A4209Syringe with needle, sterile 5 cc or greater, each→A4210Needle-free injection device, each→A4211Supplies for self-administered injections→A4212Non-coring needle or stylet with or without catheter→A4213Syringe, sterile, 20 cc or greater, each→A4215Needle, sterile, any size, each→A4216Sterile water, saline and/or dextrose, diluent/flush, 10 ml→A4217Sterile water/saline, 500 ml→A4218Sterile saline or water, metered dose dispenser, 10 ml→A4220Refill kit for implantable infusion pump→A4221Supplies for maintenance of non-insulin drug infusion catheter, per week (list drugs separately)→A4222Infusion supplies for external drug infusion pump, per cassette or bag (list drugs separately)→A4223Infusion supplies not used with external infusion pump, per cassette or bag (list drugs separately)→A4224Supplies for maintenance of insulin infusion catheter, per week→A4225Supplies for external insulin infusion pump, syringe type cartridge, sterile, each→A4226Supplies for maintenance of insulin infusion pump with dosage rate adjustment using therapeutic continuous glucose sensing, per week→A4228Supplies for maintenance of non-insulin, device-drug combination infusion catheter, per week→A4230Infusion set for external insulin pump, non needle cannula type→A4231Infusion set for external insulin pump, needle type→A4232Syringe with needle for external insulin pump, sterile, 3 cc→A4233Replacement battery, alkaline (other than j cell), for use with medically necessary home blood glucose monitor owned by patient, each→A4234Replacement battery, alkaline, j cell, for use with medically necessary home blood glucose monitor owned by patient, each→A4235Replacement battery, lithium, for use with medically necessary home blood glucose monitor owned by patient, each→A4236Replacement battery, silver oxide, for use with medically necessary home blood glucose monitor owned by patient, each→A4238Supply allowance for adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service→A4239Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service→A4244Alcohol or peroxide, per pint→A4245Alcohol wipes, per box→A4246Betadine or phisohex solution, per pint→A4247Betadine or iodine swabs/wipes, per box→A4248Chlorhexidine containing antiseptic, 1 ml→A4250Urine test or reagent strips or tablets (100 tablets or strips)→A4252Blood ketone test or reagent strip, each→A4253Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips→A4255Platforms for home blood glucose monitor, 50 per box→A4256Normal, low and high calibrator solution / chips→A4257Replacement lens shield cartridge for use with laser skin piercing device, each→A4258Spring-powered device for lancet, each→A4259Lancets, per box of 100→A4261Cervical cap for contraceptive use→A4262Temporary, absorbable lacrimal duct implant, each→A4263Permanent, long term, non-dissolvable lacrimal duct implant, each→A4264Permanent implantable contraceptive intratubal occlusion device(s) and delivery system→A4265Paraffin, per pound→A4266Diaphragm for contraceptive use→A4267Contraceptive supply, condom, male, each→A4268Contraceptive supply, condom, female, each→A4269Contraceptive supply, spermicide (e.g., foam, gel), each→A4270Disposable endoscope sheath, each→A4271Integrated lancing and blood sample testing cartridges for home blood glucose monitor, per 50 tests→A4280Adhesive skin support attachment for use with external breast prosthesis, each→A4281Tubing for breast pump, replacement→A4282Adapter for breast pump, replacement→A4283Cap for breast pump bottle, replacement→A4284Breast shield and splash protector for use with breast pump, replacement→A4285Polycarbonate bottle for use with breast pump, replacement→A4286Locking ring for breast pump, replacement→A4287Disposable collection and storage bag for breast milk, any size, any type, each→A4288Valve for breast pump, replacement→A4290Sacral nerve stimulation test lead, each→A4295Intermittent urinary catheter; straight tip, hydrophilic coating, each→A4296Intermittent urinary catheter; coude (curved) tip, hydrophilic coating, each→A4297Intermittent urinary catheter; hydrophilic coating, with insertion supplies→A4300Implantable access catheter, (e.g., venous, arterial, epidural subarachnoid, or peritoneal, etc.) external access→A4301Implantable access total catheter, port/reservoir (e.g., venous, arterial, epidural, subarachnoid, peritoneal, etc.)→A4305Disposable drug delivery system, flow rate of 50 ml or greater per hour→A4306Disposable drug delivery system, flow rate of less than 50 ml per hour→A4310Insertion tray without drainage bag and without catheter (accessories only)→A4311Insertion tray without drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.)→A4312Insertion tray without drainage bag with indwelling catheter, foley type, two-way, all silicone→A4313Insertion tray without drainage bag with indwelling catheter, foley type, three-way, for continuous irrigation→A4314Insertion tray with drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.)→A4315Insertion tray with drainage bag with indwelling catheter, foley type, two-way, all silicone→A4316Insertion tray with drainage bag with indwelling catheter, foley type, three-way, for continuous irrigation→A4318Female external urinary collection cup, with or without ring attachment, per day→A4320Irrigation tray with bulb or piston syringe, any purpose→A4321Therapeutic agent for urinary catheter irrigation→A4322Irrigation syringe, bulb or piston, each→A4326Male external catheter with integral collection chamber, any type, each→A4327Female external urinary collection device; meatal cup, each→A4328Female external urinary collection device; pouch, each→A4330Perianal fecal collection pouch with adhesive, each→A4331Extension drainage tubing, any type, any length, with connector/adaptor, for use with urinary leg bag or urostomy pouch, each→A4332Lubricant, individual sterile packet, each→A4333Urinary catheter anchoring device, adhesive skin attachment, each→A4334Urinary catheter anchoring device, leg strap, each→A4335Incontinence supply; miscellaneous→A4336Incontinence supply, urethral insert, any type, each→A4337Incontinence supply, rectal insert, any type, each→A4338Indwelling catheter; foley type, two-way latex with coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each→A4340Indwelling catheter; specialty type, (e.g., coude, mushroom, wing, etc.), each→A4341Indwelling intraurethral drainage device with valve, patient inserted, replacement only, each→A4342Accessories for patient inserted indwelling intraurethral drainage device with valve, replacement only, each→A4344Indwelling catheter, foley type, two-way, all silicone or polyurethane, each→A4346Indwelling catheter; foley type, three way for continuous irrigation, each→A4349Male external catheter, with or without adhesive, disposable, each→A4351Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each→A4352Intermittent urinary catheter; coude (curved) tip, with or without coating (teflon, silicone, or silicone elastomeric, etc.), each→A4353Intermittent urinary catheter, with insertion supplies→A4354Insertion tray with drainage bag but without catheter→A4355Irrigation tubing set for continuous bladder irrigation through a three-way indwelling foley catheter, each→A4356External urethral clamp or compression device (not to be used for catheter clamp), each→A4357Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each→A4358Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each→A4360Disposable external urethral clamp or compression device, with pad and/or pouch, each→A4361Ostomy faceplate, each→A4362Skin barrier; solid, 4 x 4 or equivalent; each→A4363Ostomy clamp, any type, replacement only, each→A4364Adhesive, liquid or equal, any type, per oz→A4366Ostomy vent, any type, each→A4367Ostomy belt, each→A4368Ostomy filter, any type, each→A4369Ostomy skin barrier, liquid (spray, brush, etc.), per oz→A4371Ostomy skin barrier, powder, per oz→A4372Ostomy skin barrier, solid 4 x 4 or equivalent, standard wear, with built-in convexity, each→A4373Ostomy skin barrier, with flange (solid, flexible or accordion), with built-in convexity, any size, each→A4375Ostomy pouch, drainable, with faceplate attached, plastic, each→A4376Ostomy pouch, drainable, with faceplate attached, rubber, each→A4377Ostomy pouch, drainable, for use on faceplate, plastic, each→A4378Ostomy pouch, drainable, for use on faceplate, rubber, each→A4379Ostomy pouch, urinary, with faceplate attached, plastic, each→A4380Ostomy pouch, urinary, with faceplate attached, rubber, each→A4381Ostomy pouch, urinary, for use on faceplate, plastic, each→A4382Ostomy pouch, urinary, for use on faceplate, heavy plastic, each→A4383Ostomy pouch, urinary, for use on faceplate, rubber, each→A4384Ostomy faceplate equivalent, silicone ring, each→A4385Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each→A4387Ostomy pouch, closed, with barrier attached, with built-in convexity (1 piece), each→A4388Ostomy pouch, drainable, with extended wear barrier attached, (1 piece), each→A4389Ostomy pouch, drainable, with barrier attached, with built-in convexity (1 piece), each→A4390Ostomy pouch, drainable, with extended wear barrier attached, with built-in convexity (1 piece), each→A4391Ostomy pouch, urinary, with extended wear barrier attached (1 piece), each→A4392Ostomy pouch, urinary, with standard wear barrier attached, with built-in convexity (1 piece), each→A4393Ostomy pouch, urinary, with extended wear barrier attached, with built-in convexity (1 piece), each→A4394Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid ounce→A4395Ostomy deodorant for use in ostomy pouch, solid, per tablet→A4396Ostomy belt with peristomal hernia support→A4398Ostomy irrigation supply; bag, each→A4399Ostomy irrigation supply; cone/catheter, with or without brush→A4400Ostomy irrigation set→A4402Lubricant, per ounce→A4404Ostomy ring, each→A4405Ostomy skin barrier, non-pectin based, paste, per ounce→A4406Ostomy skin barrier, pectin-based, paste, per ounce→A4407Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, 4 x 4 inches or smaller, each→A4408Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, with built-in convexity, larger than 4 x 4 inches, each→A4409Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each→A4410Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, larger than 4 x 4 inches, each→A4411Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, with built-in convexity, each→A4412Ostomy pouch, drainable, high output, for use on a barrier with flange (2 piece system), without filter, each→A4413Ostomy pouch, drainable, high output, for use on a barrier with flange (2 piece system), with filter, each→A4414Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each→A4415Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, larger than 4 x 4 inches, each→A4416Ostomy pouch, closed, with barrier attached, with filter (1 piece), each→A4417Ostomy pouch, closed, with barrier attached, with built-in convexity, with filter (1 piece), each→A4418Ostomy pouch, closed; without barrier attached, with filter (1 piece), each→A4419Ostomy pouch, closed; for use on barrier with non-locking flange, with filter (2 piece), each→A4420Ostomy pouch, closed; for use on barrier with locking flange (2 piece), each→A4421Ostomy supply; miscellaneous→A4422Ostomy absorbent material (sheet/pad/crystal packet) for use in ostomy pouch to thicken liquid stomal output, each→A4423Ostomy pouch, closed; for use on barrier with locking flange, with filter (2 piece), each→A4424Ostomy pouch, drainable, with barrier attached, with filter (1 piece), each→A4425Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each→A4426Ostomy pouch, drainable; for use on barrier with locking flange (2 piece system), each→A4427Ostomy pouch, drainable; for use on barrier with locking flange, with filter (2 piece system), each→A4428Ostomy pouch, urinary, with extended wear barrier attached, with faucet-type tap with valve (1 piece), each→A4429Ostomy pouch, urinary, with barrier attached, with built-in convexity, with faucet-type tap with valve (1 piece), each→A4430Ostomy pouch, urinary, with extended wear barrier attached, with built-in convexity, with faucet-type tap with valve (1 piece), each→A4431Ostomy pouch, urinary; with barrier attached, with faucet-type tap with valve (1 piece), each→A4432Ostomy pouch, urinary; for use on barrier with non-locking flange, with faucet-type tap with valve (2 piece), each→A4433Ostomy pouch, urinary; for use on barrier with locking flange (2 piece), each→A4434Ostomy pouch, urinary; for use on barrier with locking flange, with faucet-type tap with valve (2 piece), each→A4435Ostomy pouch, drainable, high output, with extended wear barrier (one-piece system), with or without filter, each→A4436Irrigation supply; sleeve, reusable, per month→A4437Irrigation supply; sleeve, disposable, per month→A4438Adhesive clip applied to the skin to secure external electrical nerve stimulator controller, each→A4450Tape, non-waterproof, per 18 square inches→A4452Tape, waterproof, per 18 square inches→A4453Rectal catheter with or without balloon, for use with any type transanal irrigation system, each→A4455Adhesive remover or solvent (for tape, cement or other adhesive), per ounce→A4456Adhesive remover, wipes, any type, each→A4457Enema tube, with or without adapter, any type, replacement only, each→A4458Enema bag with tubing, reusable→A4459Manual transanal irrigation system, includes water reservoir, pump, tubing, and accessories, without catheter, any type→A4461Surgical dressing holder, non-reusable, each→A4463Surgical dressing holder, reusable, each→A4465Non-elastic binder for extremity→A4467Belt, strap, sleeve, garment, or covering, any type→A4468Exsufflation belt, includes all supplies and accessories→A4470Gravlee jet washer→A4479Electronic transanal irrigation system, includes electronic pump, water reservoir, tubing, and accessories, without catheter, any type→A4480Vabra aspirator→A4481Tracheostoma filter, any type, any size, each→A4483Moisture exchanger, disposable, for use with invasive mechanical ventilation→A4490Surgical stockings above knee length, each→A4495Surgical stockings thigh length, each→A4500Surgical stockings below knee length, each→A4510Surgical stockings full length, each→A4520Incontinence garment, any type, (e.g., brief, diaper), each→A4540Distal transcutaneous electrical nerve stimulator, stimulates peripheral nerves of the upper arm→A4541Monthly supplies for use of device coded at e0733→A4542Supplies and accessories for external upper limb tremor stimulator of the peripheral nerves of the wrist→A4543Supplies for transcutaneous electrical nerve stimulator, for nerves in the auricular region, per month→A4544Electrode for external lower extremity nerve stimulator for restless legs syndrome→A4545Supplies and accessories for external tibial nerve stimulator (e.g., socks, gel pads, electrodes, etc.), needed for one month→A4550Surgical trays→A4553Non-disposable underpads, all sizes→A4554Disposable underpads, all sizes→A4555Electrode/transducer for use with electrical stimulation device used for cancer treatment, replacement only→A4556Electrodes, (e.g., apnea monitor), per pair→A4557Lead wires, (e.g., apnea monitor), per pair→A4558Conductive gel or paste, for use with electrical device (e.g., tens, nmes), per oz→A4559Coupling gel or paste, for use with ultrasound device, per oz→A4560Neuromuscular electrical stimulator (nmes), disposable, replacement only→A4561Pessary, reusable, rubber, any type→A4562Pessary, reusable, non rubber, any type→A4563Rectal control system for vaginal insertion, for long term use, includes pump and all supplies and accessories, any type each→A4564Pessary, disposable, any type→A4565Slings→A4566Shoulder sling or vest design, abduction restrainer, with or without swathe control, prefabricated, includes fitting and adjustment→A4570Splint→A4575Topical hyperbaric oxygen chamber, disposable→A4580Cast supplies (e.g., plaster)→A4590Special casting material (e.g., fiberglass)→A4593Neuromodulation stimulator system, adjunct to rehabilitation therapy regime, controller→A4594Neuromodulation stimulator system, adjunct to rehabilitation therapy regime, mouthpiece each→A4595Electrical stimulator supplies, 2 lead, per month, (e.g., tens, nmes)→A4596Cranial electrotherapy stimulation (ces) system supplies and accessories, per month→A4600Sleeve for intermittent limb compression device, replacement only, each→A4601Lithium ion battery, rechargeable, for non-prosthetic use, replacement→A4602Replacement battery for external infusion pump owned by patient, lithium, 1.5 volt, each→A4604Tubing with integrated heating element for use with positive airway pressure device→A4605Tracheal suction catheter, closed system, each→A4606Oxygen probe for use with oximeter device, replacement→A4608Transtracheal oxygen catheter, each→A4611Battery, heavy duty; replacement for patient owned ventilator→A4612Battery cables; replacement for patient-owned ventilator→A4613Battery charger; replacement for patient-owned ventilator→A4614Peak expiratory flow rate meter, hand held→A4615Cannula, nasal→A4616Tubing (oxygen), per foot→A4617Mouth piece→A4618Breathing circuits→A4619Face tent→A4620Variable concentration mask→A4623Tracheostomy, inner cannula→A4624Tracheal suction catheter, any type other than closed system, each→A4625Tracheostomy care kit for new tracheostomy→A4626Tracheostomy cleaning brush, each→A4627Spacer, bag or reservoir, with or without mask, for use with metered dose inhaler→A4628Oral and/or oropharyngeal suction catheter, each→A4629Tracheostomy care kit for established tracheostomy→A4630Replacement batteries, medically necessary, transcutaneous electrical stimulator, owned by patient→A4633Replacement bulb/lamp for ultraviolet light therapy system, each→A4634Replacement bulb for therapeutic light box, tabletop model→A4635Underarm pad, crutch, replacement, each→A4636Replacement, handgrip, cane, crutch, or walker, each→A4637Replacement, tip, cane, crutch, walker, each.→A4638Replacement battery for patient-owned ear pulse generator, each→A4639Replacement pad for infrared heating pad system, each→A4640Replacement pad for use with medically necessary alternating pressure pad owned by patient→A4641Radiopharmaceutical, diagnostic, not otherwise classified→A4642Indium in-111 satumomab pendetide, diagnostic, per study dose, up to 6 millicuries→A4648Tissue marker, implantable, any type, each→A4649Surgical supply; miscellaneous→A4650Implantable radiation dosimeter, each→A4651Calibrated microcapillary tube, each→A4652Microcapillary tube sealant→A4653Peritoneal dialysis catheter anchoring device, belt, each→A4657Syringe, with or without needle, each→A4660Sphygmomanometer/blood pressure apparatus with cuff and stethoscope→A4663Blood pressure cuff only→A4670Automatic blood pressure monitor→A4671Disposable cycler set used with cycler dialysis machine, each→A4672Drainage extension line, sterile, for dialysis, each→A4673Extension line with easy lock connectors, used with dialysis→A4674Chemicals/antiseptics solution used to clean/sterilize dialysis equipment, per 8 oz→A4680Activated carbon filter for hemodialysis, each→A4690Dialyzer (artificial kidneys), all types, all sizes, for hemodialysis, each→A4706Bicarbonate concentrate, solution, for hemodialysis, per gallon→A4707Bicarbonate concentrate, powder, for hemodialysis, per packet→A4708Acetate concentrate solution, for hemodialysis, per gallon→A4709Acid concentrate, solution, for hemodialysis, per gallon→A4714Treated water (deionized, distilled, or reverse osmosis) for peritoneal dialysis, per gallon→A4719"y set" tubing for peritoneal dialysis→A4720Dialysate solution, any concentration of dextrose, fluid volume greater than 249 cc, but less than or equal to 999 cc, for peritoneal dialysis→A4721Dialysate solution, any concentration of dextrose, fluid volume greater than 999 cc but less than or equal to 1999 cc, for peritoneal dialysis→A4722Dialysate solution, any concentration of dextrose, fluid volume greater than 1999 cc but less than or equal to 2999 cc, for peritoneal dialysis→A4723Dialysate solution, any concentration of dextrose, fluid volume greater than 2999 cc but less than or equal to 3999 cc, for peritoneal dialysis→A4724Dialysate solution, any concentration of dextrose, fluid volume greater than 3999 cc but less than or equal to 4999 cc, for peritoneal dialysis→A4725Dialysate solution, any concentration of dextrose, fluid volume greater than 4999 cc but less than or equal to 5999 cc, for peritoneal dialysis→A4726Dialysate solution, any concentration of dextrose, fluid volume greater than 5999 cc, for peritoneal dialysis→A4728Dialysate solution, non-dextrose containing, 500 ml→A4730Fistula cannulation set for hemodialysis, each→A4736Topical anesthetic, for dialysis, per gram→A4737Injectable anesthetic, for dialysis, per 10 ml→A4740Shunt accessory, for hemodialysis, any type, each→A4750Blood tubing, arterial or venous, for hemodialysis, each→A4755Blood tubing, arterial and venous combined, for hemodialysis, each→A4760Dialysate solution test kit, for peritoneal dialysis, any type, each→A4765Dialysate concentrate, powder, additive for peritoneal dialysis, per packet→A4766Dialysate concentrate, solution, additive for peritoneal dialysis, per 10 ml→A4770Blood collection tube, vacuum, for dialysis, per 50→A4771Serum clotting time tube, for dialysis, per 50→A4772Blood glucose test strips, for dialysis, per 50→A4773Occult blood test strips, for dialysis, per 50→A4774Ammonia test strips, for dialysis, per 50→A4802Protamine sulfate, for hemodialysis, per 50 mg→A4860Disposable catheter tips for peritoneal dialysis, per 10→A4870Plumbing and/or electrical work for home hemodialysis equipment→A4890Contracts, repair and maintenance, for hemodialysis equipment→A4911Drain bag/bottle, for dialysis, each→A4913Miscellaneous dialysis supplies, not otherwise specified→A4918Venous pressure clamp, for hemodialysis, each→A4927Gloves, non-sterile, per 100→A4928Surgical mask, per 20→A4929Tourniquet for dialysis, each→A4930Gloves, sterile, per pair→A4931Oral thermometer, reusable, any type, each→A4932Rectal thermometer, reusable, any type, each→
Procedure codeCODABLE
A4239
Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service
- Part
- HCPCS Level II
- A
- Transportation Services Including Ambulance, Medical and Surgical Supplies, Administrative, Miscellaneous and Investigational
- A4
- A4100–A4932
Source
CMS — ICD-10-PCS FY2026, HCPCS Level II october 2026, Procedure Codes 2026.