A4224 Supply insulin inf cath/wkSupplies for maintenance of insulin infusion catheter, per week
Status X: statutory exclusion, not paid under the PFS.
1 of 1 payer prior-auth lists that name A4224 require prior authorization or set conditions: Humana.
| Payer | Plan | State | Prior auth | Conditions | Since | Source |
|---|---|---|---|---|---|---|
| Humana | Humana Puerto Rico MA and Dual Medicare-Medicaid | PR | prior auth required | Nov 3, 2025 | Puerto Rico Medicare Advantage and Dual Medicare-Medicaid Plans Preauthorization and Notification List Puerto Rico Medicare Advantage and Dual Medicare-Medicaid Plan Preauthorization and Notification |
A4224 appears in 4 coverage policies from Aetna, Blue Cross & Blue Shield of Mississippi, Blue Shield of California, Capital Blue Cross.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Infusion Pumps (0161) | covered if criteria are met | Mar 31, 2026 | payer document |
| Blue Cross & Blue Shield of Mississippi | Implantable Infusion Pump (L.7.01.430) | covered if criteria are met | payer document | |
| Blue Shield of California | BSC1.03 | External Insulin Infusion Pump | listed, no stance | payer document | |
| Capital Blue Cross | External Infusion Pumps for Insulin Delivery and Automated Insulin Delivery Systems (MP 6.007) Procedure codes | covered if criteria are met | May 1, 2026 | payer document |
Prior authorization required or conditional in LA, MA, NY, OH, VA.
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.