A4255 HCPCS code: Platforms for home blood glucose monitor, 50 per box

A4255 is the HCPCS Level II code for platforms for home blood glucose monitor, 50 per box. The 2026 Medicare DMEPOS fee schedule pays $5.58 to $6.47 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. Its average fee ranks 9 of 18 A42 codes (family range $0.61–$273.28).

Code details

2026 Medicare DMEPOS fee schedule for A4255

How the A4255 fee compares

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

Covered diagnoses (461 ICD-10-CM codes)

The diagnoses most often listed as covered in the policy articles above:

Showing 10 of 461. The full list, non-covered diagnoses and CSV export are in Caduvo.

What changed for A4255

• 2026-01-01: Average state fee rose 2.0%: $5.66 to $5.77
• 1997-01-01: A4255 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 A4255?

A4255 is the HCPCS Level II code for platforms for home blood glucose monitor, 50 per box. Short descriptor: "Glucose monitor platforms".

How much does Medicare pay for A4255?

Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $5.58–$6.47. Rural fees can be higher.

Does Medicare cover A4255?

Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.

Which diagnoses support coverage for A4255?

Medicare policy articles that cite A4255 list 461 covered ICD-10-CM diagnosis codes across 1 article. 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 A4255 change in 2026?

The average non-rural state fee moved from $5.66 in 2025 to $5.77 in 2026 (+2.0%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.

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 A4255
• Watch A4255 for fee, coverage and descriptor changes
• Build a full Medicare revenue model for A4255

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.

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