A4238 HCPCS code: Supply allowance for adjunctive, non-implanted continuous glucose monitor (CGM), includes all supplies and accessories, 1 month supply = 1 unit of service
A4238 is the HCPCS Level II code for supply allowance for adjunctive, non-implanted continuous glucose monitor (CGM), includes all supplies and accessories, 1 month supply = 1 unit of service. The 2026 Medicare DMEPOS fee schedule pays $280.71 (KF, FDA Class III device) depending on the state. Its Medicare coverage code is C (Carrier judgment): Coverage is decided by the Medicare contractor (MAC) case by case. The NCCI unit limit is 3 per day on DME suppliers. Medicare volume rose 253% from 2022 to 2024 (45,838 to 161,814 services). In 2024, 66 suppliers billed Medicare for A4238 (purchases), serving 18,377 beneficiaries; Texas, Florida, California accounted for 20% of services.
Code details
| Field | Value |
|---|---|
| Section | A codes — Transportation, medical/surgical supplies and miscellaneous |
| Coverage code | C — Carrier judgment |
| Pricing indicator | 34 — DMEPOS: supplies necessary for the effective use of DME |
| BETOS category | D1E — Other durable medical equipment |
| Added | 2022-04-01 |
| Last action effective | 2023-01-01 |
2026 Medicare DMEPOS fee schedule for A4238
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| KF | FDA Class III device | $280.71 | $280.71 | — | — |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | KF | $280.71 | — |
| AL | KF | $280.71 | — |
| AR | KF | $280.71 | — |
| AZ | KF | $280.71 | — |
| CA | KF | $280.71 | — |
| CO | KF | $280.71 | — |
| CT | KF | $280.71 | — |
| DC | KF | $280.71 | — |
| DE | KF | $280.71 | — |
| FL | KF | $280.71 | — |
| GA | KF | $280.71 | — |
| HI | KF | $280.71 | — |
| IA | KF | $280.71 | — |
| ID | KF | $280.71 | — |
| IL | KF | $280.71 | — |
| IN | KF | $280.71 | — |
| KS | KF | $280.71 | — |
| KY | KF | $280.71 | — |
| LA | KF | $280.71 | — |
| MA | KF | $280.71 | — |
| MD | KF | $280.71 | — |
| ME | KF | $280.71 | — |
| MI | KF | $280.71 | — |
| MN | KF | $280.71 | — |
| MO | KF | $280.71 | — |
| MS | KF | $280.71 | — |
| MT | KF | $280.71 | — |
| NC | KF | $280.71 | — |
| ND | KF | $280.71 | — |
| NE | KF | $280.71 | — |
| NH | KF | $280.71 | — |
| NJ | KF | $280.71 | — |
| NM | KF | $280.71 | — |
| NV | KF | $280.71 | — |
| NY | KF | $280.71 | — |
| OH | KF | $280.71 | — |
| OK | KF | $280.71 | — |
| OR | KF | $280.71 | — |
| PA | KF | $280.71 | — |
| PR | KF | $280.71 | — |
| RI | KF | $280.71 | — |
| SC | KF | $280.71 | — |
| SD | KF | $280.71 | — |
| TN | KF | $280.71 | — |
| TX | KF | $280.71 | — |
| UT | KF | $280.71 | — |
| VA | KF | $280.71 | — |
| VI | KF | $280.71 | — |
| VT | KF | $280.71 | — |
| WA | KF | $280.71 | — |
| WI | KF | $280.71 | — |
| WV | KF | $280.71 | — |
| WY | KF | $280.71 | — |
How the A4238 fee compares
| Measure | Value |
|---|---|
| Rank among 2 A42 codes billed KF (lowest = 1) | 1 |
| Family fee range (average of state fees) | $280.71–$317.97 |
| Rural fee uplift | — |
Who bills A4238 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 66 |
| Referring clinicians | 7,147 |
| Medicare beneficiaries | 18,377 |
| States with claims | 51 |
| Share of services in top 3 states (Texas, Florida, California) | 20% |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 38 | 9,213 |
| 2023 | 61 | 12,737 |
| 2024 | 66 | 18,377 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for A4238, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 45,838 | 9,213 | $219.12 | $170.40 |
| 2023 | 84,720 | 12,737 | $260.98 | $196.26 |
| 2024 | 161,814 | 18,377 | $268.63 | $205.21 |
States with the most A4238 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Texas | 11,589 | $204.02 |
| Florida | 11,160 | $205.99 |
| California | 9,715 | $206.15 |
| Pennsylvania | 9,051 | $206.40 |
| New York | 7,838 | $206.56 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| DME suppliers | 3 | CMS Policy |
| outpatient hospital claims | 3 | CMS Policy |
| practitioner claims | 3 | CMS Policy |
Medicare policy articles for this code
- A52464: Glucose Monitor - Policy Article (CGS Administrators, LLC (DME MAC) Noridian Healthcare Solutions, LLC (DME MAC)) — mentions this code in its coding guidance
- 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 (495 ICD-10-CM codes)
The diagnoses most often listed as covered in the policy articles above:
| ICD-10-CM | Diagnosis | Articles listing it |
|---|---|---|
| E08.00 | Diabetes mellitus due to underlying condition with hyperosmolarity without nonketotic hyperglycemic-hyperosmolar coma (NKHHC) | 2 |
| E08.01 | Diabetes mellitus due to underlying condition with hyperosmolarity with coma | 2 |
| E08.10 | Diabetes mellitus due to underlying condition with ketoacidosis without coma | 2 |
| E08.11 | Diabetes mellitus due to underlying condition with ketoacidosis with coma | 2 |
| E08.21 | Diabetes mellitus due to underlying condition with diabetic nephropathy | 2 |
| E08.22 | Diabetes mellitus due to underlying condition with diabetic chronic kidney disease | 2 |
| E08.29 | Diabetes mellitus due to underlying condition with other diabetic kidney complication | 2 |
| E08.311 | Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy with macular edema | 2 |
| E08.319 | Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy without macular edema | 2 |
| E08.3211 | Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, right eye | 2 |
Showing 10 of 495. The full list, non-covered diagnoses and CSV export are in Caduvo.
What changed for A4238
- 2026-01-01: Average state fee (KF) rose 2.0%: $275.21 to $280.71
- 2022-04-01: A4238 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 A4238?
A4238 is the HCPCS Level II code for 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".
How much does Medicare pay for A4238?
Under the 2026 DMEPOS fee schedule, non-rural state fees are KF (FDA Class III device): $280.71. Rural fees can be higher.
Does Medicare cover A4238?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Which diagnoses support coverage for A4238?
Medicare policy articles that cite A4238 list 495 covered ICD-10-CM diagnosis codes across 2 articles. The most cited include E08.00 (Diabetes mellitus due to underlying condition with hyperosmolarity without nonketotic hyperglycemic-hyperosmolar coma (NKHHC)), E08.01 (Diabetes mellitus due to underlying condition with hyperosmolarity with coma), E08.10 (Diabetes mellitus due to underlying condition with ketoacidosis without coma). A listed diagnosis is necessary but not sufficient; the policy's other criteria still apply.
Did the Medicare fee for A4238 change in 2026?
The average non-rural state fee for KF moved from $275.21 in 2025 to $280.71 in 2026 (+2.0%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of A4238 can be billed per day?
3 on DME suppliers; 3 on outpatient hospital claims; 3 on practitioner 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 A4238
- Watch A4238 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for A4238
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.