A4928 — Surgical mask, per 20
A4928 is a HCPCS Level II code for surgical mask, per 20. 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 A4928 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 A4928
- Long descriptor
- Surgical mask, per 20
- Short descriptor
- Surgical mask
- Added
- January 1, 2002
- BETOS
- P9B
- 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 A4928
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If A4928 is not quite right, the correct code is very often within a few positions of it.
- A4802Protamine sulfate, for hemodialysis, per 50 mg
- A4860Disposable catheter tips for peritoneal dialysis, per 10
- A4870Plumbing and/or electrical work for home hemodialysis equipment
- A4890Contracts, repair and maintenance, for hemodialysis equipment
- A4911Drain bag/bottle, for dialysis, each
- A4913Miscellaneous dialysis supplies, not otherwise specified
- A4918Venous pressure clamp, for hemodialysis, each
- A4927Gloves, non-sterile, per 100
- A4929Tourniquet for dialysis, each
- A4930Gloves, sterile, per pair
- A4931Oral thermometer, reusable, any type, each
- A4932Rectal thermometer, reusable, any type, each
- A5051Ostomy pouch, closed; with barrier attached (1 piece), each
- A5052Ostomy pouch, closed; without barrier attached (1 piece), each
- A5053Ostomy pouch, closed; for use on faceplate, each
- A5054Ostomy pouch, closed; for use on barrier with flange (2 piece), each
Questions about A4928
What is HCPCS code A4928?
A4928 is a HCPCS Level II code for surgical mask, per 20. It sits in the Transportation, Medical & Surgical Supplies, Administrative section.
Does Medicare cover A4928?
The CMS HCPCS file marks A4928 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 A4928 paid under the physician fee schedule?
A4928 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.