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

HCPCS Level II code A4230 describes an infusion set for an external insulin pump using a non-needle cannula, intended as a durable medical supply for continuous subcutaneous insulin delivery; service type is insulin pump infusion supply and the typical site of service is outpatient or home-based diabetes management where patients use external insulin pumps for ongoing insulin administration.

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National Reimbursement Benchmarks

BUCA’s average commercial rate for HCPCS A4230 sits at $17.4, providing an industry reference point that is higher than most individual commercial payers listed. Blue Cross Blue Shield and Cigna exhibit moderate dispersion around their midpoints, while Aetna’s values are tightly clustered with a P75–P25 range of $10.2 ($12.0 − $1.8). UnitedHealth Group shows the narrowest spread among the given payers with a P75–P25 range of $7.5 ($63.0 − $55.5), indicating consistent upper-tier reimbursement levels.

Blue Cross Blue Shield has a P75–P25 range of $3.5 ($11.9 − $8.4), and Cigna’s interquartile spread is $9.9 ($13.5 − $4.6), reflecting greater variability in negotiated rates. Overall, dispersion is widest at Cigna and narrowest at UnitedHealth Group, with BUCA’s mean of $17.4 positioning it above the pooled means of most individual commercial carriers.

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

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Sign up for hcpcs A4230 policy alerts

Get alerted when payer policies referencing A4230 are released or updated.

Monitor payer policy activity

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National Reimbursement Benchmarks

National Payer Mean Reimbursement Rates

Clinical & Coding Specifications

Clinical Context

A 34-year-old patient with long-standing Type 1 diabetes mellitus (E10.9) managed with an external insulin pump presents for routine supplies and replacement of the insulin infusion set. The patient uses a non-needle cannula infusion set compatible with their external insulin pump. In the clinic or durable medical equipment (DME) setting, a diabetes nurse or trained diabetes educator confirms pump settings, inspects the infusion site for signs of infection or irritation, and documents the need for a replacement infusion set. The clinician documents the diagnosis (for example, E10.65 if hyperglycemia is present) and long-term insulin use (Z79.4), writes the order for the prescribed infusion set, and furnishes the device to the patient. Typical workflow steps include verification of patient identity and insurance, review of pump history and prior supplies, clinical assessment of site, ordering and dispensing the A4230 infusion set, and documentation in the medical record noting device type (non-needle cannula), quantity, and rationale for medical necessity. The usual site of service is an outpatient clinic, endocrinology office, or DME supplier; the supply is frequently used by patients at home for continuous subcutaneous insulin infusion.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`A4224`	Supplies for maintenance of insulin infusion catheter, per week (inclusive of cannulas, needles, dressings and infusion supplies)	Billed for routine weekly maintenance supplies that may overlap with or complement `A4230` when reporting comprehensive weekly supply kits.
`A4225`	Supplies for external insulin infusion pump, syringe‑type cartridge, sterile, each	Used when the pump system uses a syringe‑type cartridge rather than a cannula; related to `A4230` as an alternative supply depending on pump type.

Related Modifiers

5 rows

Modifier	Description	When to Use
52	Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…	- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
53	Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…	- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
78	CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…	- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
59	Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…	- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
62	Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…	- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…

Related Provider Taxonomies

8 rows

Taxonomy Code	Specialty	Notes
207RE0101X	Endocrinology, Diabetes & Metabolism Physician	An internist who concentrates on disorders of the internal (endocrine) glands such as the thyroid and adrenal glands. This specialist also deals with …
207Q00000X	Family Medicine Physician	Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadt…
207R00000X	Internal Medicine Physician	A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults…
282NC0060X	Critical Access Hospital	Hospitals · General Acute Care Hospital
2086S0129X	Vascular Surgery Physician	A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart.
2279P3800X	Palliative/Hospice Registered Respiratory Therapist	A coordinated plan of care to help dying patients and their families handle the burden of terminal care. Effective secretion management and relief of…
374K00000X	Religious Nonmedical Practitioner	A religious nonmedical practitioner offers spiritually-based care. Services may be rendered in an office, home, or care facility or by phone, email, …
237600000X	Audiologist-Hearing Aid Fitter	An audiologist/hearing aid fitter is the professional who specializes in evaluating and treating people with hearing loss, conducts a wide variety of …

Related ICD-10-CM Codes

30 rows

ICD-10-CM Code	Description
E08.10	Diabetes mellitus due to underlying condition with ketoacidosis without coma
E08.65	Diabetes mellitus due to underlying condition with hyperglycemia
E08.9	Diabetes mellitus due to underlying condition without complications
E09.10	Drug or chemical induced diabetes mellitus with ketoacidosis without coma
E09.65	Drug or chemical induced diabetes mellitus with hyperglycemia
E09.9	Drug or chemical induced diabetes mellitus without complications
E10.10	Type 1 diabetes mellitus with ketoacidosis without coma
E10.21	Type 1 diabetes mellitus with diabetic nephropathy
E10.22	Type 1 diabetes mellitus with diabetic chronic kidney disease
E10.65	Type 1 diabetes mellitus with hyperglycemia

Showing 1–10 of 30

Related Codes

HCPCS-A4206-STERILE-SYRINGE-1CC-NEEDLE

HCPCS A4206: Syringe with Needle, 1 cc or Less, Sterile

HCPCS-A4207-STERILE-2CC-SYRINGE-WITH-NEEDLE

HCPCS Level II A4207: Syringe with Needle, Sterile 2 cc

HCPCS-A4208-STERILE-3CC-SYRINGE-WITH-NEEDLE

HCPCS Level II A4208: Syringe with Needle, Sterile 3 cc

HCPCS-A4209-STERILE-SYRINGE-WITH-NEEDLE-5CC-OR-GREATER

HCPCS Level II A4209: Syringe with Needle, Sterile 5 cc or Greater

HCPCS-A4210-NEEDLE-FREE-INJECTION-DEVICE

HCPCS Level II A4210: Needle-free Injection Device, Each

HCPCS-A4211-SUPPLIES-SELF-ADMINISTERED-INJECTIONS

HCPCS Level II A4211: Supplies for Self-Administered Injections

HCPCS-A4212-NON-CORING-NEEDLE-STYLET-CATHETER-ACCESS-SUPPLY

HCPCS Level II A4212: Non-coring Needle or Stylet with/without Catheter

HCPCS-A4213-STERILE-SYRINGE-20CC-OR-GREATER

HCPCS Level II A4213: Syringe, Sterile, 20 cc or Greater, Each

HCPCS-A4215-STERILE-NEEDLE-SINGLE-EACH

HCPCS Level II A4215: Needle, Sterile, Any Size

HCPCS-A4216-STERILE-DILUENT-FLUSH-10ML

HCPCS Level II A4216: Sterile Diluent/Flush, 10 ml

Showing 1–10 of 633

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

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Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

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Clinical & Coding Specifications

Clinical Context

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`A4224`	Supplies for maintenance of insulin infusion catheter, per week (inclusive of cannulas, needles, dressings and infusion supplies)	Billed for routine weekly maintenance supplies that may overlap with or complement `A4230` when reporting comprehensive weekly supply kits.
`A4225`	Supplies for external insulin infusion pump, syringe‑type cartridge, sterile, each	Used when the pump system uses a syringe‑type cartridge rather than a cannula; related to `A4230` as an alternative supply depending on pump type.

Related Modifiers

5 rows

Modifier	Description	When to Use
52	Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…	- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
53	Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…	- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
78	CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…	- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
59	Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…	- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
62	Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…	- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…

Related Provider Taxonomies

8 rows

Taxonomy Code	Specialty	Notes
207RE0101X	Endocrinology, Diabetes & Metabolism Physician	An internist who concentrates on disorders of the internal (endocrine) glands such as the thyroid and adrenal glands. This specialist also deals with …
207Q00000X	Family Medicine Physician	Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadt…
207R00000X	Internal Medicine Physician	A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults…
282NC0060X	Critical Access Hospital	Hospitals · General Acute Care Hospital
2086S0129X	Vascular Surgery Physician	A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart.
2279P3800X	Palliative/Hospice Registered Respiratory Therapist	A coordinated plan of care to help dying patients and their families handle the burden of terminal care. Effective secretion management and relief of…
374K00000X	Religious Nonmedical Practitioner	A religious nonmedical practitioner offers spiritually-based care. Services may be rendered in an office, home, or care facility or by phone, email, …
237600000X	Audiologist-Hearing Aid Fitter	An audiologist/hearing aid fitter is the professional who specializes in evaluating and treating people with hearing loss, conducts a wide variety of …

Related ICD-10-CM Codes

30 rows

ICD-10-CM Code	Description
E08.10	Diabetes mellitus due to underlying condition with ketoacidosis without coma
E08.65	Diabetes mellitus due to underlying condition with hyperglycemia
E08.9	Diabetes mellitus due to underlying condition without complications
E09.10	Drug or chemical induced diabetes mellitus with ketoacidosis without coma
E09.65	Drug or chemical induced diabetes mellitus with hyperglycemia
E09.9	Drug or chemical induced diabetes mellitus without complications
E10.10	Type 1 diabetes mellitus with ketoacidosis without coma
E10.21	Type 1 diabetes mellitus with diabetic nephropathy
E10.22	Type 1 diabetes mellitus with diabetic chronic kidney disease
E10.65	Type 1 diabetes mellitus with hyperglycemia

Showing 1–10 of 30

Related Codes

HCPCS-A4206-STERILE-SYRINGE-1CC-NEEDLE

HCPCS A4206: Syringe with Needle, 1 cc or Less, Sterile

HCPCS-A4207-STERILE-2CC-SYRINGE-WITH-NEEDLE

HCPCS Level II A4207: Syringe with Needle, Sterile 2 cc

HCPCS-A4208-STERILE-3CC-SYRINGE-WITH-NEEDLE

HCPCS Level II A4208: Syringe with Needle, Sterile 3 cc

HCPCS-A4209-STERILE-SYRINGE-WITH-NEEDLE-5CC-OR-GREATER

HCPCS Level II A4209: Syringe with Needle, Sterile 5 cc or Greater

HCPCS-A4210-NEEDLE-FREE-INJECTION-DEVICE

HCPCS Level II A4210: Needle-free Injection Device, Each

HCPCS-A4211-SUPPLIES-SELF-ADMINISTERED-INJECTIONS

HCPCS Level II A4211: Supplies for Self-Administered Injections

HCPCS-A4212-NON-CORING-NEEDLE-STYLET-CATHETER-ACCESS-SUPPLY

HCPCS Level II A4212: Non-coring Needle or Stylet with/without Catheter

HCPCS-A4213-STERILE-SYRINGE-20CC-OR-GREATER

HCPCS Level II A4213: Syringe, Sterile, 20 cc or Greater, Each

HCPCS-A4215-STERILE-NEEDLE-SINGLE-EACH

HCPCS Level II A4215: Needle, Sterile, Any Size

HCPCS-A4216-STERILE-DILUENT-FLUSH-10ML

HCPCS Level II A4216: Sterile Diluent/Flush, 10 ml

Showing 1–10 of 633

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

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

Sign up for hcpcs A4230 policy alerts

National Reimbursement Benchmarks

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

Sign up for hcpcs A4230 policy alerts

National Reimbursement Benchmarks

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Codes

What does HCPCS A4230 represent and where is it typically used?

Which billing modifiers are commonly used with A4230 and in what situations should they be applied?

What do the reimbursement benchmarks indicate about commercial payer rates for A4230?

What clinical documentation and workflow elements are highlighted as relevant when furnishing A4230?

Which related HCPCS codes and diagnoses are referenced alongside A4230?

References

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Codes

What does HCPCS A4230 represent and where is it typically used?

Which billing modifiers are commonly used with A4230 and in what situations should they be applied?

What do the reimbursement benchmarks indicate about commercial payer rates for A4230?

What clinical documentation and workflow elements are highlighted as relevant when furnishing A4230?

Which related HCPCS codes and diagnoses are referenced alongside A4230?

References