How To Use HCPCS Code A4230

HCPCS code A4230 describes an infusion set for an external insulin pump, specifically the non-needle cannula type. This code is used to identify the supply needed for the administration of insulin through an insulin pump. In this article, we will explore the details of HCPCS code A4230, including its official description, procedure, when to use it, billing guidelines, historical information, Medicare and insurance coverage, and provide examples of when this code should be billed.

1. What is HCPCS A4230?

HCPCS code A4230 is used to identify the infusion set required for an external insulin pump. The non-needle cannula type is specifically indicated, which means that the set does not require the use of a needle for insulin delivery. Instead, it utilizes a cannula, a small flexible tube, to deliver insulin subcutaneously. This code is essential for accurately documenting and billing for the supply of the infusion set.

2. Official Description

The official description of HCPCS code A4230 is “Infusion set for external insulin pump, non-needle cannula type.” This description precisely defines the purpose and nature of the supply.

3. Procedure

1. Prepare the insulin pump and infusion set for use.
2. Cleanse the infusion site with an appropriate antiseptic solution.
3. Insert the non-needle cannula of the infusion set into the subcutaneous tissue.
4. Secure the infusion set in place using adhesive or other appropriate means.
5. Connect the infusion set to the insulin pump.
6. Program the insulin pump according to the patient’s prescribed insulin regimen.
7. Monitor the infusion site regularly for any signs of infection or complications.
8. Replace the infusion set as per the manufacturer’s recommendations or as needed.

4. When to use HCPCS code A4230

HCPCS code A4230 should be used when documenting and billing for the supply of an infusion set for an external insulin pump. It is specifically applicable when the infusion set is of the non-needle cannula type. This code is used in cases where patients require insulin administration through an insulin pump rather than traditional injections.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code A4230, healthcare providers need to ensure proper documentation of the following:

• Prescription or order for the infusion set
• Date of service
• Quantity of infusion sets provided
• Supplier information
• Medical necessity for the use of an external insulin pump

Providers should follow the specific billing guidelines of the payer, including any modifiers or additional documentation requirements.

6. Historical Information and Code Maintenance

HCPCS code A4230 was added to the Healthcare Common Procedure Coding System on January 01, 1996. Since its addition, there have been no maintenance actions taken for this code, as indicated by the action code N, which means no maintenance for this code. This code has been in use since its inception, and there have been no significant changes or revisions to its description or usage.

7. Medicare and Insurance Coverage

HCPCS code A4230 is eligible for coverage under Medicare and other insurance plans. The pricing indicator code for this code is 34, which indicates that it falls under the category of durable medical equipment (DME) supplies subject to pricing floors and ceilings. The multiple pricing indicator code is A, which means that the code is not applicable as HCPCS priced under one methodology.

8. Examples

Here are five examples of scenarios where HCPCS code A4230 should be billed:

1. A patient with type 1 diabetes who requires insulin administration through an external insulin pump using a non-needle cannula infusion set.
2. A patient with type 2 diabetes who has failed to achieve glycemic control with traditional insulin injections and has been prescribed an external insulin pump with a non-needle cannula infusion set.
3. A patient with gestational diabetes who requires insulin therapy during pregnancy and is using an external insulin pump with a non-needle cannula infusion set.
4. A patient with brittle diabetes who experiences frequent hypoglycemic episodes and benefits from the precise insulin delivery provided by an external insulin pump with a non-needle cannula infusion set.
5. A patient with insulin-dependent diabetes who prefers the convenience and flexibility of an external insulin pump with a non-needle cannula infusion set for insulin administration.