HCPCS Level II › A codes A4265 ParaffinParaffin, per pound
Medicare coverage: Special coverage instructions apply 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: Clinical: CMS Workgroup DME supplier: max 6 units per day (clinical), rationale: Clinical: Data Medicare pricing for A4265 DMEPOS fee schedule, July 2026 (DME26-C) no modifier, supplies (SU): non-rural $4.86 in the contiguous states; $4.86 to $5.75 in AK, HI, PR and VI; ceiling $4.86, floor $4.13 Physician Fee Schedule (CY 2026, RVU26D) Status P: bundled or excluded, no separate PFS payment.
Payer policies and prior authorization for A4265 1 of 1 payer prior-auth lists that name A4265 require prior authorization or set conditions: Rocky Mountain Health Plans.
Payer coverage policies that name A4265 A4265 appears in 1 coverage policy from Aetna.
Payer Policy Role in policy Reviewed Document Aetna Heating Devices (0540) covered if criteria are met Jul 31, 2026 payer document
Medicaid fee-for-service Prior authorization required or conditional in CO, MA, NY, OH, VA.
AZ: $5.80 (dme), effective Oct 1, 2026 CO: $3.67 (chp_plus, non-facility), effective Jul 1, 2026 FL: $4.16 (dme), effective Jul 1, 2026 IL: $3.06 (dme), effective Jan 1, 2026 IN: $4.05 (professional, Advanced Practice Nurse (85%), non-facility), effective Jan 1, 2026 KY: $3.24 (dme), effective Jan 1, 2026 MA: $3.95 (dme_rates), effective Mar 1, 2026 MS: $3.89 (comprehensive), effective Jul 1, 2026 NE: $4.24 (dme), effective Jul 1, 2026 NY: $3.36 (dme), effective Jul 1, 2026 OH: $3.37 (dme), effective Dec 15, 2002 OK: $4.86 (dme), effective Jan 1, 2026 TX: $3.23 (dmepos_tos_9_e_j_l_and_r, Home Health Dme, facility), effective May 7, 1999 VA: $4.37 (dme), effective Dec 1, 2026 VT: $0.00 (outpatient_hospital_opps), effective Feb 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.