HCPCS Code A4230: Infusion Set for External Insulin Pump, Non-Needle Cannula Type

The HCPCS code for an insulin pump infusion set is A4230 for the non-needle cannula type and A4231 for the needle type infusion set. These codes cover supplies used with external insulin pumps but the pump device itself is coded separately as E0784 (External ambulatory infusion pump, insulin).

Medicare does not cover HCPCS code A4230 because it is now considered invalid for claim submission. Supplies are bundled under HCPCS code A4224, which is the appropriate code for external insulin pump supplies used with E0784. In practice, most payers require four units of A4224 to be billed for a typical month’s supply of infusion sets. Coverage criteria and coding guidance may vary slightly by MAC and state Medicaid programs, but A4224 has effectively replaced A4230 and A4231 in nearly all Medicare claims.

The HCPCS code for epoprostenol is J1325, which is used for "Injection, epoprostenol, 0.5 mg." This code covers administration of epoprostenol, a medication primarily used to treat pulmonary arterial hypertension.

The HCPCS code for pegfilgrastim is J2506 for the injection of pegfilgrastim (non-biosimilar), 0.5 mg. Biosimilar versions have codes such as Q5108, Q5122, Q5130, Q5127, and Q5111 for different pegfilgrastim biosimilars, each representing 0.5 mg per unit.