A4226 — Supplies for maintenance of insulin infusion pump with dosage rate adjustment using therapeutic continuous glucose sensing, per week
A4226 is a HCPCS Level II code for supplies for maintenance of insulin infusion pump with dosage rate adjustment using therapeutic continuous glucose sensing, per week. It belongs to the Transportation, Medical & Surgical Supplies, Administrative section. Medicare does not pay it — see the coverage note below before you bill it.
Medicare coverage: Not payable by Medicare
Medicare does not pay this code. It may still be valid for another payer, but a Medicare claim carrying it will not be reimbursed.
From the coverage field of the CMS Alpha-Numeric HCPCS File, release 2026Q3-Jul. This states Medicare’s position on the code, not on your particular claim.
Physician fee schedule statusI
Not valid for Medicare purposes. Medicare uses another code.
Global period: XXX
Want the dollar amount for your locality? The fee calculator applies your GPCI and the current conversion factor.
Medically Unlikely Edits — units per day
The most units of A4226 Medicare will pay on one date of service. Bill more on a single line and it is denied. The limit is not the same in every setting, so the row that matters is the one matching the claim you are building.
- practitioner
- 0 — never payable MAI 3 — Date of Service Edit: Clinical · CMS Policy
- outpatient
- 0 — never payable MAI 3 — Date of Service Edit: Clinical · CMS Policy
- DME supplier
- 0 — never payable MAI 3 — Date of Service Edit: Clinical · CMS Policy
The adjudication indicator decides whether exceeding the limit is worth appealing at all: MAI 1 is a line edit you can support with documentation, MAI 3 is a date-of-service edit that is also appealable, and MAI 2 is absolute — no documentation overrides it. CMS MUE 2026Q3.
The CMS record for A4226
- Long descriptor
- Supplies for maintenance of insulin infusion pump with dosage rate adjustment using therapeutic continuous glucose sensing, per week
- Short descriptor
- Weekly supply maint cgs pump
- Added
- January 1, 2020
- BETOS
- Z2
- Pricing indicator
- 00 — Not priced by Part B
The official wording. This is what the code means.
CMS's 28-character form, which is what shows up on a remittance advice.
When CMS introduced the code.
Berenson-Eggers Type of Service — CMS's own analytic grouping.
Service not separately priced by Part B — not covered, bundled into another service, or used by Part A only.
Codes adjacent to A4226
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If A4226 is not quite right, the correct code is very often within a few positions of it.
- A4217Sterile water/saline, 500 ml
- A4218Sterile saline or water, metered dose dispenser, 10 ml
- A4220Refill kit for implantable infusion pump
- A4221Supplies for maintenance of non-insulin drug infusion catheter, per week (list drugs separately)
- A4222Infusion supplies for external drug infusion pump, per cassette or bag (list drugs separately)
- A4223Infusion supplies not used with external infusion pump, per cassette or bag (list drugs separately)
- A4224Supplies for maintenance of insulin infusion catheter, per week
- A4225Supplies for external insulin infusion pump, syringe type cartridge, sterile, each
- A4230Infusion set for external insulin pump, non needle cannula type
- A4231Infusion set for external insulin pump, needle type
- A4232Syringe with needle for external insulin pump, sterile, 3 cc
- A4233Replacement battery, alkaline (other than j cell), for use with medically necessary home blood glucose monitor owned by patient, each
- A4234Replacement battery, alkaline, j cell, for use with medically necessary home blood glucose monitor owned by patient, each
- A4235Replacement battery, lithium, for use with medically necessary home blood glucose monitor owned by patient, each
- A4236Replacement battery, silver oxide, for use with medically necessary home blood glucose monitor owned by patient, each
- A4238Supply allowance for adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service
Questions about A4226
What is HCPCS code A4226?
A4226 is a HCPCS Level II code for supplies for maintenance of insulin infusion pump with dosage rate adjustment using therapeutic continuous glucose sensing, per week. It sits in the Transportation, Medical & Surgical Supplies, Administrative section.
Does Medicare cover A4226?
The CMS HCPCS file marks A4226 as "Not payable by Medicare". Medicare does not pay this code. It may still be valid for another payer, but a Medicare claim carrying it will not be reimbursed.
How is A4226 paid under the physician fee schedule?
A4226 carries PFS status code I. Not valid for Medicare purposes. Medicare uses another code.