A4239 — Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service
HCPCS Level II A-code · short descriptor: “Non-adju cgm supply allow”
- Code system
- HCPCS Level II
- Family
- A — Medical & surgical supplies, ambulance
- Medicare coverage status
- Carrier judgment — coverage decided by the DME MAC
- DMEPOS payment category
- Supplies
- Prior authorization
- Not on Medicare required-PA list
- Face-to-face & WOPD
- Not on the required list
- MUE unit limit
- 3
- Status
- Active (HCPCS Level II October 2026)
Prior authorization
Not on the Medicare required-PA list (CMS Required Prior Authorization List — 74 items in force on 2026-10-16; 8 more from 2026-10-28; sources: CMS list updated 2026-01-13, CMS-6109-N (91 FR 47972)). Medicare Advantage and commercial plans set their own prior-authorization rules for this code — verify per plan before delivery.
Order readiness — what the written order must contain
Every Medicare DMEPOS claim needs a Standard Written Order with all six elements (42 CFR 410.38(d)):
- Beneficiary name or Medicare Beneficiary Identifier (MBI) (42 CFR 410.38(d)(1)(i)(A))
- General description of the item (42 CFR 410.38(d)(1)(i)(B))
- Quantity to be dispensed, if applicable (42 CFR 410.38(d)(1)(i)(C))
- Order date (42 CFR 410.38(d)(1)(i)(D))
- Treating practitioner name or NPI (42 CFR 410.38(d)(1)(i)(E))
- Treating practitioner signature (42 CFR 410.38(d)(1)(i)(F))
Not on the F2F/WOPD list (CMS Required F2F & WOPD List — 83 items in force on 2026-10-16; 22 more from 2026-10-28; sources: CMS list effective 2026-04-13 (91 FR 1250), CMS-6109-N (91 FR 47972)). The standard written order must reach the supplier before claim submission.
Blank requirements checklist only — MyMedi-AI never collects or stores completed orders.
A4239 Medicare fee schedule (October 2026)
Base (no modifier) Supplies
Medicare allowable: $273.28 in all listed states.
Former-CBA payment limits: ceiling $273.28 · floor $232.29
| State | Non-rural | Rural |
|---|---|---|
| AK | $273.28 | — |
| AL | $273.28 | — |
| AR | $273.28 | — |
| AZ | $273.28 | — |
| CA | $273.28 | — |
| CO | $273.28 | — |
| CT | $273.28 | — |
| DC | $273.28 | — |
| DE | $273.28 | — |
| FL | $273.28 | — |
| GA | $273.28 | — |
| HI | $273.28 | — |
| IA | $273.28 | — |
| ID | $273.28 | — |
| IL | $273.28 | — |
| IN | $273.28 | — |
| KS | $273.28 | — |
| KY | $273.28 | — |
| LA | $273.28 | — |
| MA | $273.28 | — |
| MD | $273.28 | — |
| ME | $273.28 | — |
| MI | $273.28 | — |
| MN | $273.28 | — |
| MO | $273.28 | — |
| MS | $273.28 | — |
| MT | $273.28 | — |
| NC | $273.28 | — |
| ND | $273.28 | — |
| NE | $273.28 | — |
| NH | $273.28 | — |
| NJ | $273.28 | — |
| NM | $273.28 | — |
| NV | $273.28 | — |
| NY | $273.28 | — |
| OH | $273.28 | — |
| OK | $273.28 | — |
| OR | $273.28 | — |
| PA | $273.28 | — |
| PR | $273.28 | — |
| RI | $273.28 | — |
| SC | $273.28 | — |
| SD | $273.28 | — |
| TN | $273.28 | — |
| TX | $273.28 | — |
| UT | $273.28 | — |
| VA | $273.28 | — |
| VI | $273.28 | — |
| VT | $273.28 | — |
| WA | $273.28 | — |
| WI | $273.28 | — |
| WV | $273.28 | — |
| WY | $273.28 | — |
KF Supplies
Medicare allowable: $317.97 in all listed states.
Former-CBA payment limits: ceiling $317.97 · floor $270.27
| State | Non-rural | Rural |
|---|---|---|
| AK | $317.97 | — |
| AL | $317.97 | — |
| AR | $317.97 | — |
| AZ | $317.97 | — |
| CA | $317.97 | — |
| CO | $317.97 | — |
| CT | $317.97 | — |
| DC | $317.97 | — |
| DE | $317.97 | — |
| FL | $317.97 | — |
| GA | $317.97 | — |
| HI | $317.97 | — |
| IA | $317.97 | — |
| ID | $317.97 | — |
| IL | $317.97 | — |
| IN | $317.97 | — |
| KS | $317.97 | — |
| KY | $317.97 | — |
| LA | $317.97 | — |
| MA | $317.97 | — |
| MD | $317.97 | — |
| ME | $317.97 | — |
| MI | $317.97 | — |
| MN | $317.97 | — |
| MO | $317.97 | — |
| MS | $317.97 | — |
| MT | $317.97 | — |
| NC | $317.97 | — |
| ND | $317.97 | — |
| NE | $317.97 | — |
| NH | $317.97 | — |
| NJ | $317.97 | — |
| NM | $317.97 | — |
| NV | $317.97 | — |
| NY | $317.97 | — |
| OH | $317.97 | — |
| OK | $317.97 | — |
| OR | $317.97 | — |
| PA | $317.97 | — |
| PR | $317.97 | — |
| RI | $317.97 | — |
| SC | $317.97 | — |
| SD | $317.97 | — |
| TN | $317.97 | — |
| TX | $317.97 | — |
| UT | $317.97 | — |
| VA | $317.97 | — |
| VI | $317.97 | — |
| VT | $317.97 | — |
| WA | $317.97 | — |
| WI | $317.97 | — |
| WV | $317.97 | — |
| WY | $317.97 | — |
Unit limit (MUE)
Medicare's Medically Unlikely Edit caps A4239 at 3 units per date of service (clinical). Units above the MUE deny — typically as CO-151. Rationale: CMS Policy.
Common denial codes to watch
Related A-codes
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