A4225 HCPCS code: Supplies for external insulin infusion pump, syringe type cartridge, sterile, each
A4225 is the HCPCS Level II code for supplies for external insulin infusion pump, syringe type cartridge, sterile, each. The 2026 Medicare DMEPOS fee schedule pays $3.47 to $3.96 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 1 per day on outpatient hospital claims. Medicare volume rose 1% from 2022 to 2024 (5,945,708 to 6,022,282 services). In 2024, 177 suppliers billed Medicare for A4225 (purchases), serving 61,633 beneficiaries; Florida, California, Texas accounted for 19% of services. Its average fee ranks 6 of 18 A42 codes (family range $0.61–$273.28); rural fees run 4% higher.
Code details
| Field | Value |
|---|---|
| Section | A codes — Transportation, medical/surgical supplies and miscellaneous |
| Coverage code | D — Special coverage instructions apply |
| Pricing indicator | 34 — DMEPOS: supplies necessary for the effective use of DME |
| BETOS category | D1E — Other durable medical equipment |
| Added | 2017-01-01 |
| Last action effective | 2017-01-01 |
2026 Medicare DMEPOS fee schedule for A4225
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $3.47 | $3.96 | — | — |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $3.60 | — |
| AL | — | $3.47 | $3.62 |
| AR | — | $3.47 | $3.62 |
| AZ | — | $3.47 | $3.60 |
| CA | — | $3.47 | $3.60 |
| CO | — | $3.47 | $3.62 |
| CT | — | $3.47 | $3.62 |
| DC | — | $3.47 | $3.60 |
| DE | — | $3.47 | $3.62 |
| FL | — | $3.47 | $3.60 |
| GA | — | $3.47 | $3.62 |
| HI | — | $3.60 | — |
| IA | — | $3.47 | $3.60 |
| ID | — | $3.47 | $3.60 |
| IL | — | $3.47 | $3.60 |
| IN | — | $3.47 | $3.62 |
| KS | — | $3.47 | $3.60 |
| KY | — | $3.47 | $3.62 |
| LA | — | $3.47 | $3.62 |
| MA | — | $3.47 | $3.62 |
| MD | — | $3.47 | $3.60 |
| ME | — | $3.47 | $3.62 |
| MI | — | $3.47 | $3.62 |
| MN | — | $3.47 | $3.62 |
| MO | — | $3.47 | $3.62 |
| MS | — | $3.47 | $3.62 |
| MT | — | $3.47 | $3.60 |
| NC | — | $3.47 | $3.60 |
| ND | — | $3.47 | $3.60 |
| NE | — | $3.47 | $3.60 |
| NH | — | $3.47 | $3.62 |
| NJ | — | $3.47 | $3.62 |
| NM | — | $3.47 | $3.62 |
| NV | — | $3.47 | $3.60 |
| NY | — | $3.47 | $3.62 |
| OH | — | $3.47 | $3.60 |
| OK | — | $3.47 | $3.62 |
| OR | — | $3.47 | $3.60 |
| PA | — | $3.47 | $3.62 |
| PR | — | $3.96 | — |
| RI | — | $3.47 | $3.62 |
| SC | — | $3.47 | $3.62 |
| SD | — | $3.47 | $3.60 |
| TN | — | $3.47 | $3.62 |
| TX | — | $3.47 | $3.60 |
| UT | — | $3.47 | $3.62 |
| VA | — | $3.47 | $3.60 |
| VI | — | $3.62 | — |
| VT | — | $3.47 | $3.62 |
| WA | — | $3.47 | $3.60 |
| WI | — | $3.47 | $3.62 |
| WV | — | $3.47 | $3.60 |
| WY | — | $3.47 | $3.60 |
How the A4225 fee compares
| Measure | Value |
|---|---|
| Rank among 18 A42 codes (lowest = 1) | 6 |
| Family fee range (average of state fees) | $0.61–$273.28 |
| Rural fee uplift | 3.6% |
Who bills A4225 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 177 |
| Referring clinicians | 13,973 |
| Medicare beneficiaries | 61,633 |
| States with claims | 53 |
| Share of services in top 3 states (Florida, California, Texas) | 19% |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 147 | 62,612 |
| 2023 | 154 | 61,541 |
| 2024 | 177 | 61,633 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for A4225, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 5,945,708 | 62,612 | $2.99 | $2.33 |
| 2023 | 5,956,363 | 61,541 | $3.23 | $2.48 |
| 2024 | 6,022,282 | 61,633 | $3.31 | $2.54 |
States with the most A4225 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Florida | 434,508 | $2.53 |
| California | 377,374 | $2.53 |
| Texas | 341,768 | $2.53 |
| Pennsylvania | 324,235 | $2.53 |
| New York | 278,136 | $2.55 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 1 | Nature of Equipment |
Medicare policy articles for this code
- A52507: External Infusion Pumps - Policy Article (CGS Administrators, LLC (DME MAC) Noridian Healthcare Solutions, LLC (DME MAC)) — mentions this code in its coding guidance
Covered diagnoses (460 ICD-10-CM codes)
The diagnoses most often listed as covered in the policy articles above:
| ICD-10-CM | Diagnosis | Articles listing it |
|---|---|---|
| C91.00 | Acute lymphoblastic leukemia not having achieved remission | 1 |
| C91.01 | Acute lymphoblastic leukemia, in remission | 1 |
| C91.02 | Acute lymphoblastic leukemia, in relapse | 1 |
| D80.0 | Hereditary hypogammaglobulinemia | 1 |
| D80.2 | Selective deficiency of immunoglobulin A [IgA] | 1 |
| D80.3 | Selective deficiency of immunoglobulin G [IgG] subclasses | 1 |
| D80.4 | Selective deficiency of immunoglobulin M [IgM] | 1 |
| D80.5 | Immunodeficiency with increased immunoglobulin M [IgM] | 1 |
| D80.6 | Antibody deficiency with near-normal immunoglobulins or with hyperimmunoglobulinemia | 1 |
| D80.7 | Transient hypogammaglobulinemia of infancy | 1 |
Showing 10 of 460. The full list, non-covered diagnoses and CSV export are in Caduvo.
What changed for A4225
- 2026-01-01: Average state fee rose 2.6%: $3.40 to $3.49
- 2017-01-01: A4225 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 A4225?
A4225 is the HCPCS Level II code for supplies for external insulin infusion pump, syringe type cartridge, sterile, each. Short descriptor: "Sup/ext insulin inf pump syr".
How much does Medicare pay for A4225?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $3.47–$3.96. Rural fees can be higher.
Does Medicare cover A4225?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
Which diagnoses support coverage for A4225?
Medicare policy articles that cite A4225 list 460 covered ICD-10-CM diagnosis codes across 1 article. The most cited include C91.00 (Acute lymphoblastic leukemia not having achieved remission), C91.01 (Acute lymphoblastic leukemia, in remission), C91.02 (Acute lymphoblastic leukemia, in relapse). A listed diagnosis is necessary but not sufficient; the policy's other criteria still apply.
Did the Medicare fee for A4225 change in 2026?
The average non-rural state fee moved from $3.40 in 2025 to $3.49 in 2026 (+2.6%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of A4225 can be billed per day?
1 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
- A4216 — Sterile water, saline and/or dextrose, diluent/flush, 10 ml ($0.53–$0.99)
- A4217 — Sterile water/saline, 500 ml ($2.18–$4.93)
- A4218 — Sterile saline or water, metered dose dispenser, 10 ml
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 A4225
- Watch A4225 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for A4225
Sources: CMS HCPCS Level II release October 2025; 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.