Browse HCPCS Level II 2020 Edition

A4244 - A4290  Medical and Surgical Supplies - Miscellaneous Supplies

A4244 Alcohol or peroxide, per pint short Alcohol or peroxide per pint RVU CPT Modifier Physician Component Facility Practice Nonfacility Practice Professional Liability Insurance Total Facility Total Nonfacility Global Period 0.0 0.0 0.0 0.0 0.0 0.0 XXX MUE Location Value Ajudication Indicator Rationale PRA 0.0 3 Date of Service Edit: Clinical CMS Policy OPH 1.0 3 Date of Service Edit: Clinical Clinical: Data DME 0.0 3 Date of Service Edit: Clinical CMS Policy

A4245 Alcohol wipes, per box short Alcohol wipes per box RVU CPT Modifier Physician Component Facility Practice Nonfacility Practice Professional Liability Insurance Total Facility Total Nonfacility Global Period 0.0 0.0 0.0 0.0 0.0 0.0 XXX MUE Location Value Ajudication Indicator Rationale PRA 0.0 3 Date of Service Edit: Clinical CMS Policy OPH 1.0 3 Date of Service Edit: Clinical Clinical: CMS Workgroup DME 0.0 3 Date of Service Edit: Clinical CMS Policy

A4246 Betadine or phisohex solution, per pint short Betadine/phisohex solution RVU CPT Modifier Physician Component Facility Practice Nonfacility Practice Professional Liability Insurance Total Facility Total Nonfacility Global Period 0.0 0.0 0.0 0.0 0.0 0.0 XXX MUE Location Value Ajudication Indicator Rationale PRA 0.0 3 Date of Service Edit: Clinical CMS Policy OPH 1.0 3 Date of Service Edit: Clinical Clinical: Data DME 0.0 3 Date of Service Edit: Clinical CMS Policy

A4247 Betadine or iodine swabs/wipes, per box short Betadine/iodine swabs/wipes RVU CPT Modifier Physician Component Facility Practice Nonfacility Practice Professional Liability Insurance Total Facility Total Nonfacility Global Period 0.0 0.0 0.0 0.0 0.0 0.0 XXX MUE Location Value Ajudication Indicator Rationale PRA 0.0 3 Date of Service Edit: Clinical CMS Policy OPH 1.0 3 Date of Service Edit: Clinical Clinical: Data DME 0.0 3 Date of Service Edit: Clinical CMS Policy

A4248 Chlorhexidine containing antiseptic, 1 ml short Chlorhexidine antisept RVU CPT Modifier Physician Component Facility Practice Nonfacility Practice Professional Liability Insurance Total Facility Total Nonfacility Global Period 0.0 0.0 0.0 0.0 0.0 0.0 XXX MUE Location Value Ajudication Indicator Rationale PRA 0.0 3 Date of Service Edit: Clinical CMS Policy OPH 10.0 3 Date of Service Edit: Clinical Clinical: CMS Workgroup DME 0.0 3 Date of Service Edit: Clinical CMS Policy

A4250 Urine test or reagent strips or tablets (100 tablets or strips) short Urine reagent strips/tablets RVU CPT Modifier Physician Component Facility Practice Nonfacility Practice Professional Liability Insurance Total Facility Total Nonfacility Global Period 0.0 0.0 0.0 0.0 0.0 0.0 XXX MUE Location Value Ajudication Indicator Rationale PRA 0.0 3 Date of Service Edit: Clinical CMS Policy OPH 0.0 3 Date of Service Edit: Clinical CMS Policy DME 0.0 3 Date of Service Edit: Clinical CMS Policy

A4252 Blood ketone test or reagent strip, each short Blood ketone test or strip RVU CPT Modifier Physician Component Facility Practice Nonfacility Practice Professional Liability Insurance Total Facility Total Nonfacility Global Period 0.0 0.0 0.0 0.0 0.0 0.0 XXX MUE Location Value Ajudication Indicator Rationale PRA 0.0 3 Date of Service Edit: Clinical CMS Policy OPH 0.0 3 Date of Service Edit: Clinical CMS Policy DME 0.0 3 Date of Service Edit: Clinical CMS Policy

A4253 Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips short Blood glucose/reagent strips RVU CPT Modifier Physician Component Facility Practice Nonfacility Practice Professional Liability Insurance Total Facility Total Nonfacility Global Period 0.0 0.0 0.0 0.0 0.0 0.0 XXX MUE Location Value Ajudication Indicator Rationale PRA 0.0 3 Date of Service Edit: Clinical CMS Policy OPH 0.0 3 Date of Service Edit: Clinical CMS Policy DME 1.0 3 Date of Service Edit: Clinical Nature of Equipment

A4255 Platforms for home blood glucose monitor, 50 per box short Glucose monitor platforms RVU CPT Modifier Physician Component Facility Practice Nonfacility Practice Professional Liability Insurance Total Facility Total Nonfacility Global Period 0.0 0.0 0.0 0.0 0.0 0.0 XXX MUE Location Value Ajudication Indicator Rationale PRA 0.0 3 Date of Service Edit: Clinical CMS Policy OPH 0.0 3 Date of Service Edit: Clinical CMS Policy DME 0.0 3 Date of Service Edit: Clinical Nature of Equipment

A4256 Normal, low and high calibrator solution / chips short Calibrator solution/chips RVU CPT Modifier Physician Component Facility Practice Nonfacility Practice Professional Liability Insurance Total Facility Total Nonfacility Global Period 0.0 0.0 0.0 0.0 0.0 0.0 XXX MUE Location Value Ajudication Indicator Rationale PRA 0.0 3 Date of Service Edit: Clinical CMS Policy OPH 1.0 3 Date of Service Edit: Clinical Clinical: CMS Workgroup DME 2.0 3 Date of Service Edit: Clinical Clinical: Data

A4257 Replacement lens shield cartridge for use with laser skin piercing device, each short Replace lensshield cartridge RVU CPT Modifier Physician Component Facility Practice Nonfacility Practice Professional Liability Insurance Total Facility Total Nonfacility Global Period 0.0 0.0 0.0 0.0 0.0 0.0 XXX MUE Location Value Ajudication Indicator Rationale PRA 0.0 3 Date of Service Edit: Clinical CMS Policy OPH 0.0 3 Date of Service Edit: Clinical CMS Policy DME 0.0 3 Date of Service Edit: Clinical Nature of Equipment

A4258 Spring-powered device for lancet, each short Lancet device each RVU CPT Modifier Physician Component Facility Practice Nonfacility Practice Professional Liability Insurance Total Facility Total Nonfacility Global Period 0.0 0.0 0.0 0.0 0.0 0.0 XXX MUE Location Value Ajudication Indicator Rationale PRA 0.0 3 Date of Service Edit: Clinical CMS Policy OPH 0.0 3 Date of Service Edit: Clinical CMS Policy DME 1.0 2 Date of Service Edit: Policy Published Contractor Policy

A4259 Lancets, per box of 100 short Lancets per box RVU CPT Modifier Physician Component Facility Practice Nonfacility Practice Professional Liability Insurance Total Facility Total Nonfacility Global Period 0.0 0.0 0.0 0.0 0.0 0.0 XXX MUE Location Value Ajudication Indicator Rationale PRA 0.0 3 Date of Service Edit: Clinical CMS Policy OPH 0.0 3 Date of Service Edit: Clinical CMS Policy DME 1.0 3 Date of Service Edit: Clinical Nature of Equipment

A4261 Cervical cap for contraceptive use short Cervical cap contraceptive RVU CPT Modifier Physician Component Facility Practice Nonfacility Practice Professional Liability Insurance Total Facility Total Nonfacility Global Period 0.0 0.0 0.0 0.0 0.0 0.0 XXX MUE Location Value Ajudication Indicator Rationale PRA 0.0 3 Date of Service Edit: Clinical CMS Policy OPH 0.0 3 Date of Service Edit: Clinical CMS Policy

A4262 Temporary, absorbable lacrimal duct implant, each short Temporary tear duct plug RVU CPT Modifier Physician Component Facility Practice Nonfacility Practice Professional Liability Insurance Total Facility Total Nonfacility Global Period 0.0 0.0 0.0 0.0 0.0 0.0 XXX MUE Location Value Ajudication Indicator Rationale PRA 0.0 3 Date of Service Edit: Clinical CMS Policy OPH 4.0 2 Date of Service Edit: Policy Anatomic Consideration

A4263 Permanent, long term, non-dissolvable lacrimal duct implant, each short Permanent tear duct plug RVU CPT Modifier Physician Component Facility Practice Nonfacility Practice Professional Liability Insurance Total Facility Total Nonfacility Global Period 0.0 0.0 0.0 0.0 0.0 0.0 XXX MUE Location Value Ajudication Indicator Rationale PRA 0.0 3 Date of Service Edit: Clinical CMS Policy OPH 4.0 2 Date of Service Edit: Policy Anatomic Consideration

A4264 Permanent implantable contraceptive intratubal occlusion device(s) and delivery system short Intratubal occlusion device RVU CPT Modifier Physician Component Facility Practice Nonfacility Practice Professional Liability Insurance Total Facility Total Nonfacility Global Period 0.0 0.0 0.0 0.0 0.0 0.0 XXX MUE Location Value Ajudication Indicator Rationale PRA 0.0 3 Date of Service Edit: Clinical CMS Policy OPH 0.0 3 Date of Service Edit: Clinical CMS Policy

A4265 Paraffin, per pound short Paraffin RVU CPT Modifier Physician Component Facility Practice Nonfacility Practice Professional Liability Insurance Total Facility Total Nonfacility Global Period 0.0 0.0 0.0 0.0 0.0 0.0 XXX MUE Location Value Ajudication Indicator Rationale PRA 0.0 3 Date of Service Edit: Clinical CMS Policy OPH 1.0 3 Date of Service Edit: Clinical Clinical: CMS Workgroup

A4266 Diaphragm for contraceptive use short Diaphragm RVU CPT Modifier Physician Component Facility Practice Nonfacility Practice Professional Liability Insurance Total Facility Total Nonfacility Global Period 0.0 0.0 0.0 0.0 0.0 0.0 XXX MUE Location Value Ajudication Indicator Rationale PRA 0.0 3 Date of Service Edit: Clinical CMS Policy OPH 0.0 3 Date of Service Edit: Clinical CMS Policy

A4267 Contraceptive supply, condom, male, each short Male condom RVU CPT Modifier Physician Component Facility Practice Nonfacility Practice Professional Liability Insurance Total Facility Total Nonfacility Global Period 0.0 0.0 0.0 0.0 0.0 0.0 XXX MUE Location Value Ajudication Indicator Rationale PRA 0.0 3 Date of Service Edit: Clinical CMS Policy OPH 0.0 3 Date of Service Edit: Clinical CMS Policy

A4268 Contraceptive supply, condom, female, each short Female condom RVU CPT Modifier Physician Component Facility Practice Nonfacility Practice Professional Liability Insurance Total Facility Total Nonfacility Global Period 0.0 0.0 0.0 0.0 0.0 0.0 XXX MUE Location Value Ajudication Indicator Rationale PRA 0.0 3 Date of Service Edit: Clinical CMS Policy OPH 0.0 3 Date of Service Edit: Clinical CMS Policy

A4269 Contraceptive supply, spermicide (e.g., foam, gel), each short Spermicide RVU CPT Modifier Physician Component Facility Practice Nonfacility Practice Professional Liability Insurance Total Facility Total Nonfacility Global Period 0.0 0.0 0.0 0.0 0.0 0.0 XXX MUE Location Value Ajudication Indicator Rationale PRA 0.0 3 Date of Service Edit: Clinical CMS Policy OPH 0.0 3 Date of Service Edit: Clinical CMS Policy

A4270 Disposable endoscope sheath, each short Disposable endoscope sheath RVU CPT Modifier Physician Component Facility Practice Nonfacility Practice Professional Liability Insurance Total Facility Total Nonfacility Global Period 0.0 0.0 0.0 0.0 0.0 0.0 XXX MUE Location Value Ajudication Indicator Rationale PRA 0.0 3 Date of Service Edit: Clinical CMS Policy OPH 3.0 3 Date of Service Edit: Clinical Clinical: Data

A4280 Adhesive skin support attachment for use with external breast prosthesis, each short Brst prsths adhsv attchmnt RVU CPT Modifier Physician Component Facility Practice Nonfacility Practice Professional Liability Insurance Total Facility Total Nonfacility Global Period 0.0 0.0 0.0 0.0 0.0 0.0 XXX MUE Location Value Ajudication Indicator Rationale PRA 0.0 3 Date of Service Edit: Clinical CMS Policy OPH 1.0 3 Date of Service Edit: Clinical Clinical: CMS Workgroup

A4281 Tubing for breast pump, replacement short Replacement breastpump tube RVU CPT Modifier Physician Component Facility Practice Nonfacility Practice Professional Liability Insurance Total Facility Total Nonfacility Global Period 0.0 0.0 0.0 0.0 0.0 0.0 XXX MUE Location Value Ajudication Indicator Rationale PRA 0.0 3 Date of Service Edit: Clinical CMS Policy OPH 0.0 3 Date of Service Edit: Clinical CMS Policy DME 0.0 3 Date of Service Edit: Clinical CMS Policy

A4282 Adapter for breast pump, replacement short Replacement breastpump adpt RVU CPT Modifier Physician Component Facility Practice Nonfacility Practice Professional Liability Insurance Total Facility Total Nonfacility Global Period 0.0 0.0 0.0 0.0 0.0 0.0 XXX MUE Location Value Ajudication Indicator Rationale PRA 0.0 3 Date of Service Edit: Clinical CMS Policy OPH 0.0 3 Date of Service Edit: Clinical CMS Policy DME 0.0 3 Date of Service Edit: Clinical CMS Policy

A4283 Cap for breast pump bottle, replacement short Replacement breastpump cap RVU CPT Modifier Physician Component Facility Practice Nonfacility Practice Professional Liability Insurance Total Facility Total Nonfacility Global Period 0.0 0.0 0.0 0.0 0.0 0.0 XXX MUE Location Value Ajudication Indicator Rationale PRA 0.0 3 Date of Service Edit: Clinical CMS Policy OPH 0.0 3 Date of Service Edit: Clinical CMS Policy DME 0.0 3 Date of Service Edit: Clinical CMS Policy

A4284 Breast shield and splash protector for use with breast pump, replacement short Replcmnt breast pump shield RVU CPT Modifier Physician Component Facility Practice Nonfacility Practice Professional Liability Insurance Total Facility Total Nonfacility Global Period 0.0 0.0 0.0 0.0 0.0 0.0 XXX MUE Location Value Ajudication Indicator Rationale PRA 0.0 3 Date of Service Edit: Clinical CMS Policy OPH 0.0 3 Date of Service Edit: Clinical CMS Policy DME 0.0 3 Date of Service Edit: Clinical CMS Policy

A4285 Polycarbonate bottle for use with breast pump, replacement short Replcmnt breast pump bottle RVU CPT Modifier Physician Component Facility Practice Nonfacility Practice Professional Liability Insurance Total Facility Total Nonfacility Global Period 0.0 0.0 0.0 0.0 0.0 0.0 XXX MUE Location Value Ajudication Indicator Rationale PRA 0.0 3 Date of Service Edit: Clinical CMS Policy OPH 0.0 3 Date of Service Edit: Clinical CMS Policy DME 0.0 3 Date of Service Edit: Clinical CMS Policy

A4286 Locking ring for breast pump, replacement short Replcmnt breastpump lok ring RVU CPT Modifier Physician Component Facility Practice Nonfacility Practice Professional Liability Insurance Total Facility Total Nonfacility Global Period 0.0 0.0 0.0 0.0 0.0 0.0 XXX MUE Location Value Ajudication Indicator Rationale PRA 0.0 3 Date of Service Edit: Clinical CMS Policy OPH 0.0 3 Date of Service Edit: Clinical CMS Policy DME 0.0 3 Date of Service Edit: Clinical CMS Policy

A4290 Sacral nerve stimulation test lead, each short Sacral nerve stim test lead RVU CPT Modifier Physician Component Facility Practice Nonfacility Practice Professional Liability Insurance Total Facility Total Nonfacility Global Period 0.0 0.0 0.0 0.0 0.0 0.0 XXX MUE Location Value Ajudication Indicator Rationale PRA 2.0 3 Date of Service Edit: Clinical Clinical: Data OPH 2.0 3 Date of Service Edit: Clinical Clinical: Data