A4280 HCPCS code: Adhesive skin support attachment for use with external breast prosthesis, each
A4280 is the HCPCS Level II code for adhesive skin support attachment for use with external breast prosthesis, each. The 2026 Medicare DMEPOS fee schedule pays $7.38 to $8.13 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 60 per day on DME suppliers. In 2023, 3 suppliers billed Medicare for A4280 (purchases), serving 0 beneficiaries. Its average fee ranks 10 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 | C — Carrier judgment |
| Pricing indicator | 38 — DMEPOS: orthotics, prosthetics, prosthetic devices and vision services |
| BETOS category | D1F — Prosthetic and orthotic devices |
| Added | 2000-01-01 |
| Last action effective | 2000-01-01 |
2026 Medicare DMEPOS fee schedule for A4280
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $7.38 | $8.13 | $9.08 | $6.81 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $7.46 | — |
| AL | — | $7.61 | — |
| AR | — | $7.61 | — |
| AZ | — | $7.38 | — |
| CA | — | $7.38 | — |
| CO | — | $7.64 | — |
| CT | — | $7.77 | — |
| DC | — | $7.38 | — |
| DE | — | $7.38 | — |
| FL | — | $7.61 | — |
| GA | — | $7.61 | — |
| HI | — | $8.00 | — |
| IA | — | $7.52 | — |
| ID | — | $7.38 | — |
| IL | — | $7.59 | — |
| IN | — | $7.59 | — |
| KS | — | $7.52 | — |
| KY | — | $7.61 | — |
| LA | — | $7.61 | — |
| MA | — | $7.77 | — |
| MD | — | $7.38 | — |
| ME | — | $7.77 | — |
| MI | — | $7.59 | — |
| MN | — | $7.59 | — |
| MO | — | $7.52 | — |
| MS | — | $7.61 | — |
| MT | — | $7.64 | — |
| NC | — | $7.61 | — |
| ND | — | $7.64 | — |
| NE | — | $7.52 | — |
| NH | — | $7.77 | — |
| NJ | — | $7.52 | — |
| NM | — | $7.61 | — |
| NV | — | $7.38 | — |
| NY | — | $7.52 | — |
| OH | — | $7.59 | — |
| OK | — | $7.61 | — |
| OR | — | $7.38 | — |
| PA | — | $7.38 | — |
| PR | — | $8.13 | — |
| RI | — | $7.77 | — |
| SC | — | $7.61 | — |
| SD | — | $7.64 | — |
| TN | — | $7.61 | — |
| TX | — | $7.61 | — |
| UT | — | $7.64 | — |
| VA | — | $7.38 | — |
| VI | — | $8.13 | — |
| VT | — | $7.77 | — |
| WA | — | $7.38 | — |
| WI | — | $7.59 | — |
| WV | — | $7.38 | — |
| WY | — | $7.64 | — |
How the A4280 fee compares
| Measure | Value |
|---|---|
| Rank among 18 A42 codes (lowest = 1) | 10 |
| Family fee range (average of state fees) | $0.61–$273.28 |
| Rural fee uplift | — |
Who bills A4280 (2023)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 3 |
| Referring clinicians | 7 |
| Medicare beneficiaries | 0 |
| States with claims | 0 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for A4280, 2023–2023
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2023 | 543 | 0 | $4.86 | $3.81 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| DME suppliers | 60 | Nature of Service/Procedure |
| outpatient hospital claims | 1 | Clinical: CMS Workgroup |
Medicare policy articles for this code
- A52478: External Breast Prostheses - Policy Article (CGS Administrators, LLC (DME MAC) Noridian Healthcare Solutions, LLC (DME MAC)) — mentions this code in its coding guidance
Covered diagnoses (49 ICD-10-CM codes)
The diagnoses most often listed as covered in the policy articles above:
| ICD-10-CM | Diagnosis | Articles listing it |
|---|---|---|
| C50.011 | Malignant neoplasm of nipple and areola, right female breast | 1 |
| C50.012 | Malignant neoplasm of nipple and areola, left female breast | 1 |
| C50.019 | Malignant neoplasm of nipple and areola, unspecified female breast | 1 |
| C50.111 | Malignant neoplasm of central portion of right female breast | 1 |
| C50.112 | Malignant neoplasm of central portion of left female breast | 1 |
| C50.119 | Malignant neoplasm of central portion of unspecified female breast | 1 |
| C50.211 | Malignant neoplasm of upper-inner quadrant of right female breast | 1 |
| C50.212 | Malignant neoplasm of upper-inner quadrant of left female breast | 1 |
| C50.219 | Malignant neoplasm of upper-inner quadrant of unspecified female breast | 1 |
| C50.311 | Malignant neoplasm of lower-inner quadrant of right female breast | 1 |
Showing 10 of 49. The full list, non-covered diagnoses and CSV export are in Caduvo.
What changed for A4280
- 2026-01-01: Average state fee rose 2.0%: $7.44 to $7.59
- 2000-01-01: A4280 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 A4280?
A4280 is the HCPCS Level II code for adhesive skin support attachment for use with external breast prosthesis, each. Short descriptor: "Brst prsths adhsv attchmnt".
How much does Medicare pay for A4280?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $7.38–$8.13. Rural fees can be higher.
Does Medicare cover A4280?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Which diagnoses support coverage for A4280?
Medicare policy articles that cite A4280 list 49 covered ICD-10-CM diagnosis codes across 1 article. The most cited include C50.011 (Malignant neoplasm of nipple and areola, right female breast), C50.012 (Malignant neoplasm of nipple and areola, left female breast), C50.019 (Malignant neoplasm of nipple and areola, unspecified female breast). A listed diagnosis is necessary but not sufficient; the policy's other criteria still apply.
Did the Medicare fee for A4280 change in 2026?
The average non-rural state fee moved from $7.44 in 2025 to $7.59 in 2026 (+2.0%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of A4280 can be billed per day?
60 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 A4280
- Watch A4280 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for A4280
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.