HCPCS Range Other Supplies Including Diabetes Supplies and Contraceptives

• 1 Alcohol or peroxide, per pint ( A4244 )

• 2 Alcohol wipes, per box ( A4245 )

• 3 Betadine or pHisoHex solution, per pint ( A4246 )

• 4 Betadine or iodine swabs/wipes, per box ( A4247 )

• 5 Chlorhexidine containing antiseptic, 1 ml ( A4248 )

• 6 Urine test or reagent strips or tablets (100 tablets or strips) ( A4250 )

• 7 Blood ketone test or reagent strip, each ( A4252 )

• 8 Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips ( A4253 )

• 9 Platforms for home blood glucose monitor, 50 per box ( A4255 )

• 10 Normal, low and high calibrator solution / chips ( A4256 )

• 11 Replacement lens shield cartridge for use with laser skin piercing device, each ( A4257 )

• 12 Spring-powered device for lancet, each ( A4258 )

• 13 Lancets, per box of 100 ( A4259 )

• 14 Cervical cap for contraceptive use ( A4261 )

• 15 Temporary, absorbable lacrimal duct implant, each ( A4262 )

• 16 Permanent, long term, non-dissolvable lacrimal duct implant, each ( A4263 )

• 17 Permanent implantable contraceptive intratubal occlusion device(s) and delivery system ( A4264 )

• 18 Paraffin, per pound ( A4265 )

• 19 Diaphragm for contraceptive use ( A4266 )

• 20 Contraceptive supply, condom, male, each ( A4267 )

• 21 Contraceptive supply, condom, female, each ( A4268 )

• 22 Contraceptive supply, spermicide (e.g., foam, gel), each ( A4269 )

• 23 Disposable endoscope sheath, each ( A4270 )

• 24 Adhesive skin support attachment for use with external breast prosthesis, each ( A4280 )

• 25 Tubing for breast pump, replacement ( A4281 )

• 26 Adapter for breast pump, replacement ( A4282 )

• 27 Cap for breast pump bottle, replacement ( A4283 )

• 28 Breast shield and splash protector for use with breast pump, replacement ( A4284 )

• 29 Polycarbonate bottle for use with breast pump, replacement ( A4285 )

• 30 Locking ring for breast pump, replacement ( A4286 )

• 31 Sacral nerve stimulation test lead, each ( A4290 )

• 32 Disposable collection and storage bag for breast milk, any size, any type, each ( A4287 )

• 33 Integrated lancing and blood sample testing cartridges for home blood glucose monitor, per month ( A4271 )