HCPCS Level II › A codes A4221 Supp non-insulin inf cath/wkSupplies for maintenance of non-insulin drug infusion catheter, per week (list drugs separately)
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 1 units per day (clinical), rationale: Code Descriptor / CPT Instruction DME supplier: max 4 units per day (clinical), rationale: Clinical: Data Medicare pricing for A4221 DMEPOS fee schedule, July 2026 (DME26-C) no modifier, supplies (SU): non-rural $25.87 in the contiguous states; $28.95 to $32.30 in AK, HI, PR and VI; rural $28.80 to $29.07 Physician Fee Schedule (CY 2026, RVU26D) Status X: statutory exclusion, not paid under the PFS.
Payer policies and prior authorization for A4221 Payer coverage policies that name A4221 A4221 appears in 5 coverage policies from Aetna, Anthem, Blue Cross & Blue Shield of Mississippi.
Payer Policy Role in policy Reviewed Document Aetna Diabetes Tests, Programs and Supplies (0070) covered if criteria are met Feb 20, 2026 payer document Aetna Infusion Pumps (0161) covered if criteria are met Mar 31, 2026 payer document Aetna Nusinersen (Spinraza) (0915) listed, no stance Sep 9, 2026 payer document Anthem External Infusion Pumps for the Administration of Drugs in the Home or Residential Care Settings (CG-DME-21) covered if criteria are met Nov 6, 2025 payer document Blue Cross & Blue Shield of Mississippi Implantable Infusion Pump (L.7.01.430) covered if criteria are met payer document
Medicaid fee-for-service Prior authorization required or conditional in KY, LA, MA, ND, NY, OH, WV.
AZ: $27.78 (dme), effective Oct 1, 2026 CO: $22.73 (dme), effective Jul 1, 2026 FL: $18.58 (dme), effective Jul 1, 2026 IL: $21.16 (dme), effective Jan 1, 2026 IN: $21.41 (professional, Advanced Practice Nurse (85%), non-facility), effective Jan 1, 2026 KS: $20.70 (default), effective Jul 1, 2026 KY: $19.71 (dme), effective Jan 1, 2026 MA: $20.79 (dme_rates), effective Mar 1, 2026 MD: $21.99 (dme), effective Apr 1, 2026 MS: $23.26 (comprehensive), effective Jul 1, 2026 ND: $0.00 (dme), effective Aug 1, 2026 NE: $23.60 (dme), effective Jul 1, 2026 NY: $20.20 (dme), effective Jul 1, 2026 OH: $20.55 (dme), effective Jan 1, 1998 OK: $25.87 (dme), effective Jan 1, 2026 TX: $16.61 (dmepos_tos_9_e_j_l_and_r, Medical Supplier (Dme), non-facility), effective Mar 1, 2022 VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $24.96 (home_infusion_parenteral_nutrition), 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.