A4257 HCPCS code: Replacement lens shield cartridge for use with laser skin piercing device, each

A4257 is the HCPCS Level II code for replacement lens shield cartridge for use with laser skin piercing device, each. The 2026 Medicare DMEPOS fee schedule pays $18.19 to $21.83 depending on the state. Its Medicare coverage code is C (Carrier judgment): Coverage is decided by the Medicare contractor (MAC) case by case. Its average fee ranks 13 of 18 A42 codes (family range $0.61–$273.28).

Code details

2026 Medicare DMEPOS fee schedule for A4257

How the A4257 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 A4257

• 2026-01-01: Average state fee rose 2.0%: $17.90 to $18.26
• 2002-01-01: A4257 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 A4257?

A4257 is the HCPCS Level II code for replacement lens shield cartridge for use with laser skin piercing device, each. Short descriptor: "Replace lensshield cartridge".

How much does Medicare pay for A4257?

Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $18.19–$21.83. Rural fees can be higher.

Does Medicare cover A4257?

Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.

Which diagnoses support coverage for A4257?

Medicare policy articles that cite A4257 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 A4257 change in 2026?

The average non-rural state fee moved from $17.90 in 2025 to $18.26 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 A4257
• Watch A4257 for fee, coverage and descriptor changes
• Build a full Medicare revenue model for A4257

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.

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