A4216 HCPCS code: Sterile water, saline and/or dextrose, diluent/flush, 10 ml
A4216 is the HCPCS Level II code for sterile water, saline and/or dextrose, diluent/flush, 10 ml. The 2026 Medicare DMEPOS fee schedule pays $0.53 to $0.99 depending on the state. Its Medicare coverage code is D (Special coverage instructions apply): Medicare covers it when its national or local coverage criteria are met. The NCCI unit limit is 25 per day on outpatient hospital claims. Medicare volume fell 5% from 2022 to 2024 (800,572 to 759,998 services). In 2024, 769 suppliers billed Medicare for A4216 (purchases), serving 3,269 beneficiaries; New York, California, Texas accounted for 31% of services. Its average fee ranks 1 of 18 A42 codes (family range $0.61–$273.28).
Code details
| Field | Value |
|---|---|
| Section | A codes — Transportation, medical/surgical supplies and miscellaneous |
| Coverage code | D — Special coverage instructions apply |
| Pricing indicator | 37 — DMEPOS: ostomy, tracheostomy and urological supplies |
| BETOS category | D1F — Prosthetic and orthotic devices |
| Added | 2004-01-01 |
| Last action effective | 2007-01-01 |
2026 Medicare DMEPOS fee schedule for A4216
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $0.53 | $0.99 | $0.63 | $0.54 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $0.99 | — |
| AL | — | $0.58 | — |
| AR | — | $0.63 | — |
| AZ | — | $0.62 | — |
| CA | — | $0.63 | — |
| CO | — | $0.63 | — |
| CT | — | $0.63 | — |
| DC | — | $0.63 | — |
| DE | — | $0.63 | — |
| FL | — | $0.58 | — |
| GA | — | $0.63 | — |
| HI | — | $0.97 | — |
| IA | — | $0.63 | — |
| ID | — | $0.54 | — |
| IL | — | $0.54 | — |
| IN | — | $0.63 | — |
| KS | — | $0.54 | — |
| KY | — | $0.54 | — |
| LA | — | $0.63 | — |
| MA | — | $0.63 | — |
| MD | — | $0.62 | — |
| ME | — | $0.63 | — |
| MI | — | $0.63 | — |
| MN | — | $0.63 | — |
| MO | — | $0.63 | — |
| MS | — | $0.63 | — |
| MT | — | $0.63 | — |
| NC | — | $0.54 | — |
| ND | — | $0.58 | — |
| NE | — | $0.62 | — |
| NH | — | $0.63 | — |
| NJ | — | $0.63 | — |
| NM | — | $0.63 | — |
| NV | — | $0.63 | — |
| NY | — | $0.55 | — |
| OH | — | $0.54 | — |
| OK | — | $0.54 | — |
| OR | — | $0.54 | — |
| PA | — | $0.63 | — |
| PR | — | $0.53 | — |
| RI | — | $0.54 | — |
| SC | — | $0.63 | — |
| SD | — | $0.54 | — |
| TN | — | $0.54 | — |
| TX | — | $0.54 | — |
| UT | — | $0.63 | — |
| VA | — | $0.58 | — |
| VI | — | $0.55 | — |
| VT | — | $0.63 | — |
| WA | — | $0.54 | — |
| WI | — | $0.63 | — |
| WV | — | $0.58 | — |
| WY | — | $0.63 | — |
How the A4216 fee compares
| Measure | Value |
|---|---|
| Rank among 18 A42 codes (lowest = 1) | 1 |
| Family fee range (average of state fees) | $0.61–$273.28 |
| Rural fee uplift | — |
Who bills A4216 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 769 |
| Referring clinicians | 3,059 |
| Medicare beneficiaries | 3,269 |
| States with claims | 49 |
| Share of services in top 3 states (New York, California, Texas) | 31% |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 781 | 3,242 |
| 2023 | 752 | 3,211 |
| 2024 | 769 | 3,269 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for A4216, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 800,572 | 3,242 | $0.50 | $0.38 |
| 2023 | 781,969 | 3,211 | $0.55 | $0.42 |
| 2024 | 759,998 | 3,269 | $0.56 | $0.43 |
States with the most A4216 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| New York | 105,562 | $0.40 |
| California | 72,634 | $0.47 |
| Texas | 54,911 | $0.39 |
| New Jersey | 49,368 | $0.45 |
| Pennsylvania | 45,061 | $0.47 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 25 | Clinical: CMS Workgroup |
Medicare policy articles for this code
- A52519: Suction Pumps - Policy Article (CGS Administrators, LLC (DME MAC) Noridian Healthcare Solutions, LLC (DME MAC)) — mentions this code in its coding guidance
Covered diagnoses (8 ICD-10-CM codes)
The diagnoses most often listed as covered in the policy articles above:
| ICD-10-CM | Diagnosis | Articles listing it |
|---|---|---|
| J95.00 | Unspecified tracheostomy complication | 1 |
| J95.01 | Hemorrhage from tracheostomy stoma | 1 |
| J95.02 | Infection of tracheostomy stoma | 1 |
| J95.03 | Malfunction of tracheostomy stoma | 1 |
| J95.04 | Tracheo-esophageal fistula following tracheostomy | 1 |
| J95.09 | Other tracheostomy complication | 1 |
| Z43.0 | Encounter for attention to tracheostomy | 1 |
| Z93.0 | Tracheostomy status | 1 |
What changed for A4216
- 2026-01-01: Average state fee rose 1.7%: $0.60 to $0.61
- 2004-01-01: A4216 added to HCPCS Level II
- Next scheduled CMS quarterly update (HCPCS and DMEPOS fee schedule): 2027-01-01
Frequently asked questions
What is HCPCS code A4216?
A4216 is the HCPCS Level II code for sterile water, saline and/or dextrose, diluent/flush, 10 ml. Short descriptor: "Sterile water/saline, 10 ml".
How much does Medicare pay for A4216?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $0.53–$0.99. Rural fees can be higher.
Does Medicare cover A4216?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
Which diagnoses support coverage for A4216?
Medicare policy articles that cite A4216 list 8 covered ICD-10-CM diagnosis codes across 1 article. The most cited include J95.00 (Unspecified tracheostomy complication), J95.01 (Hemorrhage from tracheostomy stoma), J95.02 (Infection of tracheostomy stoma). A listed diagnosis is necessary but not sufficient; the policy's other criteria still apply.
Did the Medicare fee for A4216 change in 2026?
The average non-rural state fee moved from $0.60 in 2025 to $0.61 in 2026 (+1.7%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of A4216 can be billed per day?
25 on outpatient hospital claims (NCCI medically unlikely edits).
Related A42 codes
- A4206 — Syringe with needle, sterile, 1 cc or less, each
- A4207 — Syringe with needle, sterile 2 cc, each
- A4208 — Syringe with needle, sterile 3 cc, each
- A4209 — Syringe with needle, sterile 5 cc or greater, each
- A4210 — Needle-free injection device, each
- A4211 — Supplies for self-administered injections
- A4212 — Non-coring needle or stylet with or without catheter
- A4213 — Syringe, sterile, 20 cc or greater, each
- A4215 — Needle, sterile, any size, each
- A4217 — Sterile water/saline, 500 ml ($2.18–$4.93)
- A4218 — Sterile saline or water, metered dose dispenser, 10 ml
- A4220 — Refill kit for implantable infusion pump
Building a device that would bill under a code like this? Caduvo matches a device description to HCPCS/CPT codes, Medicare coverage and payment, and the FDA pathway in one report.
Next steps
- Run a reimbursement report for a device billed under A4216
- Watch A4216 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for A4216
Sources: CMS HCPCS Level II release October 2026; CMS DMEPOS fee schedule 2026; CMS NCCI MUE tables; CMS Medicare utilization (physician and DME supplier files); CMS Medicare Coverage Database articles. Fees are Medicare allowables, not commercial rates. Not billing or legal advice.