HCPCS Level II › A codes A4282 Replacement breastpump adptAdapter for breast pump, replacement
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 0 units per day (clinical), rationale: CMS Policy DME supplier: max 0 units per day (clinical), rationale: CMS Policy Medicare pricing for A4282 Physician Fee Schedule (CY 2026, RVU26D) Status X: statutory exclusion, not paid under the PFS.
Payer policies and prior authorization for A4282 Payer coverage policies that name A4282 A4282 appears in 2 coverage policies from Aetna, Premera Blue Cross.
Payer Policy Role in policy Reviewed Document Aetna Breast Pumps (0421) covered if criteria are met Jun 30, 2026 payer document Premera Blue Cross Preventive CareProcedure Code(s) | Comments covered if criteria are met Sep 21, 2026 payer document
Medicaid fee-for-service Prior authorization required or conditional in CO, LA, MA.
CO: $0.59 (health_first_colorado), effective Jul 1, 2026 KS: $2.00 (default), effective Sep 1, 2007 LA: $13.00 (dme), effective Jan 1, 2019 MA: $28.35 (dme_rates), effective Mar 1, 2026 OH: $4.60 (dme), effective Jan 1, 2022 TX: $0.62 (dmepos_tos_9_e_j_l_and_r, Home Health Dme, non-facility), effective Apr 1, 2017 VT: $6.57 (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.