How To Use HCPCS Code A4226

HCPCS code A4226 describes the supplies for the maintenance of an insulin infusion pump with dosage rate adjustment using therapeutic continuous glucose sensing, on a weekly basis. This code is used to identify the specific supplies required for the ongoing operation and monitoring of the insulin infusion pump.

1. What is HCPCS A4226?

HCPCS code A4226 is a specific code used in medical coding to identify the supplies needed for the maintenance of an insulin infusion pump with dosage rate adjustment using therapeutic continuous glucose sensing, per week. It is important to note that this code is not applicable for other types of insulin pumps or maintenance procedures.

2. Official Description

The official description of HCPCS code A4226 is “Supplies for maintenance of insulin infusion pump with dosage rate adjustment using therapeutic continuous glucose sensing, per week.” The short description for this code is “Weekly supply maint cgs pump.”

3. Procedure

1. Ensure that the insulin infusion pump is properly set up and functioning.
2. Calibrate the therapeutic continuous glucose sensing system according to the manufacturer’s instructions.
3. Monitor the glucose levels of the patient using the continuous glucose sensing system.
4. Adjust the dosage rate of the insulin infusion pump based on the glucose readings.
5. Replace any necessary supplies for the insulin infusion pump, such as tubing, reservoirs, or sensors, on a weekly basis.

4. When to use HCPCS code A4226

HCPCS code A4226 should be used when billing for the supplies required for the maintenance of an insulin infusion pump with dosage rate adjustment using therapeutic continuous glucose sensing, per week. It is important to ensure that the patient meets the specific criteria for using this code, such as having a medical necessity for an insulin infusion pump and therapeutic continuous glucose sensing.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code A4226, healthcare providers should ensure that they have the necessary documentation to support the medical necessity of the insulin infusion pump and therapeutic continuous glucose sensing. This may include medical records, physician orders, and any other relevant documentation. Additionally, providers should follow the specific billing guidelines set forth by Medicare or other insurance carriers to ensure accurate and timely reimbursement.

6. Historical Information and Code Maintenance

HCPCS code A4226 was added to the Healthcare Common Procedure Coding System on January 01, 2020. As of September 15, 2020, there have been no maintenance actions taken for this code, as indicated by the action code N, which means no maintenance for this code. It is important for medical coders and billers to stay updated on any changes or revisions to this code in order to ensure accurate coding and billing practices.

7. Medicare and Insurance Coverage

HCPCS code A4226 is not payable by Medicare, as indicated by the coverage code I, which means it is not payable by Medicare. The pricing indicator code for this code is 00, which means that the service is not separately priced by Part B. This may indicate that the service is bundled or not covered by Medicare. The multiple pricing indicator code is 9, which means it is not applicable as HCPCS is not priced separately by Part B or the value is not established. It is important for healthcare providers to check with individual insurance carriers to determine coverage and reimbursement for HCPCS code A4226.

8. Examples

Here are five examples of when HCPCS code A4226 should be billed:

1. A patient with type 1 diabetes who requires an insulin infusion pump and therapeutic continuous glucose sensing for precise insulin dosage adjustments.
2. A patient with type 2 diabetes who has failed to achieve adequate glucose control with multiple daily injections and is transitioning to an insulin infusion pump with therapeutic continuous glucose sensing.
3. A patient with gestational diabetes who requires an insulin infusion pump and therapeutic continuous glucose sensing for precise insulin dosage adjustments during pregnancy.
4. A patient with brittle diabetes who experiences frequent fluctuations in blood glucose levels and requires an insulin infusion pump and therapeutic continuous glucose sensing for better glucose control.
5. A patient with insulin-dependent diabetes who is participating in a clinical trial evaluating the effectiveness of an insulin infusion pump with therapeutic continuous glucose sensing.