A4284 — Breast shield and splash protector for use with breast pump, replacement
A4284 is a HCPCS Level II code for breast shield and splash protector for use with breast pump, replacement. It belongs to the Transportation, Medical & Surgical Supplies, Administrative section. Whether Medicare pays it depends on the coverage rule below.
Medicare coverage: Carrier judgment
Coverage is decided by your Medicare contractor, not by national policy. Whether this is paid depends on the LCD for your jurisdiction and on what the documentation supports.
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 A4284 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 A4284
- Long descriptor
- Breast shield and splash protector for use with breast pump, replacement
- Short descriptor
- Replcmnt breast pump shield
- Added
- January 1, 2003
- 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 A4284
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If A4284 is not quite right, the correct code is very often within a few positions of it.
- A4268Contraceptive supply, condom, female, each
- A4269Contraceptive supply, spermicide (e.g., foam, gel), each
- A4270Disposable endoscope sheath, each
- A4271Integrated lancing and blood sample testing cartridges for home blood glucose monitor, per 50 tests
- A4280Adhesive skin support attachment for use with external breast prosthesis, each
- A4281Tubing for breast pump, replacement
- A4282Adapter for breast pump, replacement
- A4283Cap for breast pump bottle, replacement
- A4285Polycarbonate bottle for use with breast pump, replacement
- A4286Locking ring for breast pump, replacement
- A4287Disposable collection and storage bag for breast milk, any size, any type, each
- A4288Valve for breast pump, replacement
- A4290Sacral nerve stimulation test lead, each
- A4295Intermittent urinary catheter; straight tip, hydrophilic coating, each
- A4296Intermittent urinary catheter; coude (curved) tip, hydrophilic coating, each
- A4297Intermittent urinary catheter; hydrophilic coating, with insertion supplies
Questions about A4284
What is HCPCS code A4284?
A4284 is a HCPCS Level II code for breast shield and splash protector for use with breast pump, replacement. It sits in the Transportation, Medical & Surgical Supplies, Administrative section.
Does Medicare cover A4284?
The CMS HCPCS file marks A4284 as "Carrier judgment". Coverage is decided by your Medicare contractor, not by national policy. Whether this is paid depends on the LCD for your jurisdiction and on what the documentation supports.
How is A4284 paid under the physician fee schedule?
A4284 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.