`A4210` Nonneedle injection device

Needle-free injection device, each

Medicare coverage: Non-covered by Medicare
Status: active (October 2026 file)

Medically Unlikely Edits (effective October 1, 2026)

Practitioner: max 0 units per day (clinical), rationale: CMS Policy
Outpatient hospital: max 0 units per day (clinical), rationale: CMS Policy
DME supplier: max 0 units per day (clinical), rationale: CMS Policy

Medicare pricing for A4210

Physician Fee Schedule (CY 2026, RVU26D)

Status N: non-covered service.

Payer policies and prior authorization for A4210

Payer coverage policies that name A4210

A4210 appears in 3 coverage policies from Aetna, Blue Cross & Blue Shield of Mississippi, Blue Cross Blue Shield of Massachusetts.

Payer	Policy	Role in policy	Reviewed	Document
Aetna	Diabetes Tests, Programs and Supplies (0070) Remote Glucose monitor, MiniMed Connect, Skin microvascular flow-motion - no specific code [e.g. Dexcom SHARE - no additional reimbursement provided]	not covered	Feb 20, 2026	payer document
Blue Cross & Blue Shield of Mississippi	Needlefree Insulin Injection Systems (L.2.01.403)	unproven / investigational		payer document
Blue Cross Blue Shield of Massachusetts	Insulin Delivery Devices (332)	listed, no stance		payer document

Medicaid fee-for-service

Prior authorization required or conditional in KY, LA, MA, OH, VA.

CO: $6.61 (chp_plus, non-facility), effective Jul 1, 2026
IN: $0.33 (professional, Advanced Practice Nurse (85%), non-facility), effective Jan 1, 2026
KY: $36.67 (dme), effective Jan 1, 2026
LA: $1.74 (dme), effective Sep 1, 2012
MD: $6.26 (dme), effective Apr 1, 2026
OK: $33.68 (dme), effective Aug 1, 2020
VA: $0.09 (dme), effective Dec 1, 2026
VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026
WA: $0.15 (medical_equipment_supplies), effective Jul 1, 2026
WY: $0.00 (outpatient_hospital_apc, Children's Hospitals), effective Apr 1, 2026

From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.

A4210 Nonneedle injection device