A4230 — Infusion set for external insulin pump, non needle cannula type
A4230 is a HCPCS Level II code for infusion set for external insulin pump, non needle cannula type. It belongs to the Transportation, Medical & Surgical Supplies, Administrative section. Whether Medicare pays it depends on the coverage rule below.
Medicare coverage: Special coverage instructions apply
There are published conditions attached to this code. Check the applicable coverage policy before billing it: the code being valid is not the same as the service being covered.
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 statusX
Statutory exclusion. The item or service is not within the statutory definition of 'physician services', so the fee schedule never pays it.
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 A4230 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
- 1 unit MAI 3 — Date of Service Edit: Clinical · Clinical: CMS Workgroup
- DME supplier
- 0 — never payable MAI 3 — Date of Service Edit: Clinical · Published Contractor 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 A4230
- Long descriptor
- Infusion set for external insulin pump, non needle cannula type
- Short descriptor
- Infus insulin pump non needl
- Added
- January 1, 1996
- BETOS
- D1E
- Pricing indicator
- 34 — DMEPOS
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.
DME supplies. Price subject to floors and ceilings.
Codes adjacent to A4230
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If A4230 is not quite right, the correct code is very often within a few positions of it.
- 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
- A4226Supplies for maintenance of insulin infusion pump with dosage rate adjustment using therapeutic continuous glucose sensing, per week
- 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
- A4239Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service
Questions about A4230
What is HCPCS code A4230?
A4230 is a HCPCS Level II code for infusion set for external insulin pump, non needle cannula type. It sits in the Transportation, Medical & Surgical Supplies, Administrative section.
Does Medicare cover A4230?
The CMS HCPCS file marks A4230 as "Special coverage instructions apply". There are published conditions attached to this code. Check the applicable coverage policy before billing it: the code being valid is not the same as the service being covered.
How is A4230 paid under the physician fee schedule?
A4230 carries PFS status code X. Statutory exclusion. The item or service is not within the statutory definition of 'physician services', so the fee schedule never pays it.