A4290 HCPCS code: Sacral nerve stimulation test lead, each
A4290 is the HCPCS Level II code for sacral nerve stimulation test lead, each. Its Medicare coverage code is C (Carrier judgment): Coverage is decided by the Medicare contractor (MAC) case by case. The NCCI unit limit is 2 per day on outpatient hospital claims.
Code details
| Field | Value |
|---|---|
| Section | A codes — Transportation, medical/surgical supplies and miscellaneous |
| Coverage code | C — Carrier judgment |
| Pricing indicator | 00 — Not separately priced by Medicare |
| BETOS category | Z2 |
| Added | 2001-01-01 |
| Last action effective | 2002-01-01 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 2 | Clinical: Data |
| practitioner claims | 2 | Clinical: Data |
Medicare policy articles for this code
- A53359: Billing and Coding: Sacral Nerve Stimulation for Urinary and Fecal Incontinence (Noridian Healthcare Solutions, LLC (MAC - Part A, MAC - Part B))
- A55835: Billing and Coding: Sacral Nerve Stimulation for Urinary and Fecal Incontinence (CGS Administrators, LLC (MAC - Part A, MAC - Part B))
- A59332: Billing and Coding: Sacral Nerve Stimulation for the Treatment of Urinary and Fecal Incontinence (Palmetto GBA (MAC - Part A, MAC - Part B))
Covered diagnoses (47 ICD-10-CM codes)
The diagnoses most often listed as covered in the policy articles above:
| ICD-10-CM | Diagnosis | Articles listing it |
|---|---|---|
| N30.10 | Interstitial cystitis (chronic) without hematuria | 3 |
| N30.11 | Interstitial cystitis (chronic) with hematuria | 3 |
| N39.41 | Urge incontinence | 3 |
| N39.42 | Incontinence without sensory awareness | 3 |
| N39.46 | Mixed incontinence | 3 |
| N39.490 | Overflow incontinence | 3 |
| N39.492 | Postural (urinary) incontinence | 3 |
| N39.498 | Other specified urinary incontinence | 3 |
| R15.9 | Full incontinence of feces | 3 |
| R33.0 | Drug induced retention of urine | 3 |
Showing 10 of 47. The full list, non-covered diagnoses and CSV export are in Caduvo.
What changed for A4290
- 2001-01-01: A4290 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 A4290?
A4290 is the HCPCS Level II code for sacral nerve stimulation test lead, each. Short descriptor: "Sacral nerve stim test lead".
Does Medicare cover A4290?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Which diagnoses support coverage for A4290?
Medicare policy articles that cite A4290 list 47 covered ICD-10-CM diagnosis codes across 3 articles. The most cited include N30.10 (Interstitial cystitis (chronic) without hematuria), N30.11 (Interstitial cystitis (chronic) with hematuria), N39.41 (Urge incontinence). A listed diagnosis is necessary but not sufficient; the policy's other criteria still apply.
How many units of A4290 can be billed per day?
2 on outpatient hospital claims; 2 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 A4290
- Watch A4290 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for A4290
Sources: CMS HCPCS Level II release October 2025; CMS DMEPOS fee schedule; 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.