A4265 HCPCS code: Paraffin, per pound
A4265 is the HCPCS Level II code for paraffin, per pound. The 2026 Medicare DMEPOS fee schedule pays $4.86 to $5.75 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 6 per day on DME suppliers. Medicare volume rose 4% from 2022 to 2024 (732 to 760 services). In 2024, 24 suppliers billed Medicare for A4265 (purchases), serving 70 beneficiaries. Its average fee ranks 8 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 | 34 — DMEPOS: supplies necessary for the effective use of DME |
| BETOS category | D1E — Other durable medical equipment |
| Added | 1986-01-01 |
| Last action effective | 2002-01-01 |
2026 Medicare DMEPOS fee schedule for A4265
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $4.86 | $5.75 | $4.86 | $4.13 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $4.86 | — |
| AL | — | $4.86 | — |
| AR | — | $4.86 | — |
| AZ | — | $4.86 | — |
| CA | — | $4.86 | — |
| CO | — | $4.86 | — |
| CT | — | $4.86 | — |
| DC | — | $4.86 | — |
| DE | — | $4.86 | — |
| FL | — | $4.86 | — |
| GA | — | $4.86 | — |
| HI | — | $4.86 | — |
| IA | — | $4.86 | — |
| ID | — | $4.86 | — |
| IL | — | $4.86 | — |
| IN | — | $4.86 | — |
| KS | — | $4.86 | — |
| KY | — | $4.86 | — |
| LA | — | $4.86 | — |
| MA | — | $4.86 | — |
| MD | — | $4.86 | — |
| ME | — | $4.86 | — |
| MI | — | $4.86 | — |
| MN | — | $4.86 | — |
| MO | — | $4.86 | — |
| MS | — | $4.86 | — |
| MT | — | $4.86 | — |
| NC | — | $4.86 | — |
| ND | — | $4.86 | — |
| NE | — | $4.86 | — |
| NH | — | $4.86 | — |
| NJ | — | $4.86 | — |
| NM | — | $4.86 | — |
| NV | — | $4.86 | — |
| NY | — | $4.86 | — |
| OH | — | $4.86 | — |
| OK | — | $4.86 | — |
| OR | — | $4.86 | — |
| PA | — | $4.86 | — |
| PR | — | $5.75 | — |
| RI | — | $4.86 | — |
| SC | — | $4.86 | — |
| SD | — | $4.86 | — |
| TN | — | $4.86 | — |
| TX | — | $4.86 | — |
| UT | — | $4.86 | — |
| VA | — | $4.86 | — |
| VI | — | $4.86 | — |
| VT | — | $4.86 | — |
| WA | — | $4.86 | — |
| WI | — | $4.86 | — |
| WV | — | $4.86 | — |
| WY | — | $4.86 | — |
How the A4265 fee compares
| Measure | Value |
|---|---|
| Rank among 18 A42 codes (lowest = 1) | 8 |
| Family fee range (average of state fees) | $0.61–$273.28 |
| Rural fee uplift | — |
Who bills A4265 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 24 |
| Referring clinicians | 55 |
| Medicare beneficiaries | 70 |
| States with claims | 3 |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 26 | 89 |
| 2023 | 26 | 89 |
| 2024 | 24 | 70 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for A4265, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 732 | 89 | $4.10 | $3.12 |
| 2023 | 963 | 89 | $4.45 | $3.25 |
| 2024 | 760 | 70 | $4.57 | $3.42 |
States with the most A4265 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| California | 373 | $3.48 |
| New York | 277 | $3.27 |
| Colorado | 16 | $3.19 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| DME suppliers | 6 | Clinical: Data |
| outpatient hospital claims | 1 | Clinical: CMS Workgroup |
What changed for A4265
- 2026-01-01: Average state fee rose 2.1%: $4.78 to $4.88
- 1986-01-01: A4265 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 A4265?
A4265 is the HCPCS Level II code for paraffin, per pound. Short descriptor: "Paraffin".
How much does Medicare pay for A4265?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $4.86–$5.75. Rural fees can be higher.
Does Medicare cover A4265?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
Did the Medicare fee for A4265 change in 2026?
The average non-rural state fee moved from $4.78 in 2025 to $4.88 in 2026 (+2.1%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of A4265 can be billed per day?
6 on DME suppliers; 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 A4265
- Watch A4265 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for A4265
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.