HCPCS Level II › A codes A4213 20+ cc syringe onlySyringe, sterile, 20 cc or greater, each
Medicare coverage: Carrier judgment 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 5 units per day (clinical), rationale: Clinical: Data DME supplier: max 0 units per day (clinical), rationale: CMS Policy Medicare pricing for A4213 Physician Fee Schedule (CY 2026, RVU26D) Status X: statutory exclusion, not paid under the PFS.
Payer policies and prior authorization for A4213 Payer coverage policies that name A4213 A4213 appears in 1 coverage policy from Aetna.
Payer Policy Role in policy Reviewed Document Aetna Diabetes Tests, Programs and Supplies (0070) covered if criteria are met Feb 20, 2026 payer document
Medicaid fee-for-service Prior authorization required or conditional in CO, KY, LA, OH, VA, WV.
AZ: $0.45 (outpatient_hospital), effective Oct 1, 2011 CO: $2.06 (chp_plus, non-facility), effective Jul 1, 2026 FL: $2.08 (dme), effective Jul 1, 2026 IL: $1.03 (dme), effective Jan 1, 2026 IN: $1.23 (professional, Advanced Practice Nurse (85%), non-facility), effective Jan 1, 2026 KS: $0.25 (default), effective Jun 1, 2007 KY: $1.67 (dme), effective Jan 1, 2026 MA: $0.76 (dme_rates), effective Mar 1, 2026 MD: $1.77 (dme), effective Apr 1, 2026 MS: $1.09 (comprehensive), effective Jul 1, 2026 ND: $0.73 (dme), effective Aug 1, 2026 NE: $1.43 (dme), effective Jul 1, 2026 NY: $0.63 (dme), effective Jul 1, 2026 OH: $0.60 (dme), effective Nov 22, 1990 OK: $0.59 (dme), effective Aug 1, 2020 TX: $0.49 (dmepos_tos_9_e_j_l_and_r, Home Health Dme, non-facility), effective Apr 1, 2017 VA: $0.57 (dme), effective Dec 1, 2026 VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $0.23 (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.