A4265: Paraffin, per pound

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 2026Q4-Oct. This states Medicare’s position on the code, not on your particular claim.

Physician fee schedule statusP

Bundled or excluded. No RVUs and no payment: either bundled into another service or paid under a different provision of the Act.

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 A4265 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

6 units

MAI 3: Date of Service Edit: Clinical · Clinical: Data

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.