Summary & Overview
HCPCS A9274: External Ambulatory Disposable Insulin Delivery System
HCPCS Level II code A9274 designates a disposable external ambulatory insulin delivery system supplied as a complete kit with all necessary supplies and accessories. This code captures single-use devices intended for outpatient or home-based insulin administration and is relevant to durable medical equipment (DME) and outpatient supply billing. Nationally, utilization of disposable insulin delivery systems affects coverage decisions, DME billing workflows, and patient access to ambulatory diabetes management.
Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the code’s clinical purpose and service context, typical sites of service, and which major payers commonly adjudicate claims with this code. The publication also summarizes available benchmarks for coverage and reimbursement, highlights recent policy or coding guidance where applicable, and situates the code within broader ambulatory diabetes care billing considerations.
This summary is intended for billing managers, DME suppliers, revenue cycle professionals, and policy analysts seeking a national perspective on coding, payer coverage patterns, and operational implications for dispensing disposable ambulatory insulin delivery systems.
Billing Code Overview
HCPCS Level II code A9274 describes an external ambulatory insulin delivery system, disposable, each, including all supplies and accessories. This code covers a single-use, disposable device intended for ambulatory insulin delivery and is typically provided as a complete kit including the device and the necessary consumable supplies.
Service Type: Durable medical supply / ambulatory insulin delivery device
Typical Site of Service: Outpatient ambulatory settings, home use, or other non-inpatient environments where patients self-administer insulin
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient receiving A9274 is an adult with insulin-requiring diabetes mellitus who needs a short-term, external ambulatory disposable insulin delivery system (for example, a tubeless or patch-type disposable pump) that includes all supplies and accessories. A common scenario: a patient with type 1 diabetes discharged from the hospital after diabetic ketoacidosis stabilization requires an outpatient, disposable insulin delivery system for ongoing insulin administration during a transitional period while long-term durable pump options are arranged. The outpatient endocrinology or diabetes management nurse coordinates device selection, patient education, supply scheduling, and prior authorization with the patient’s commercial payor or Medicare. The device is provided to the patient in the clinic or delivered to the home with documentation of device model, lot number, start date, and training. Follow-up visits with endocrinology or primary care occur within 1–4 weeks to assess glycemic control, device tolerance, and supply needs.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier | Use when no other modifier applies to the service. |
22 |