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 2026Q4-Oct. 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 2026Q4.
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
- A4228Supplies for maintenance of non-insulin, device-drug combination infusion catheter, per week
- 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