HCPCS Code A4244: Alcohol or peroxide billing guide

Key Takeaways

HCPCS code A4244 describes alcohol or peroxide, per pint: a Level II DMEPOS supply code in the A-series maintained by CMS.

A4244 is explicitly non-covered by Medicare when billed alongside glucose monitoring equipment: CMS Policy Article A52464 denies this pairing under reason code GL015 because alcohol or peroxide is not required for the proper functioning of the device.

Modifier requirements and competitive bidding program rules vary by geographic locality: verify with your MAC before submitting claims.

Pabau’s claims management software helps DMEPOS suppliers track A4244 billing, modifiers, and documentation requirements in one place.

HCPCS code A4244 is a Level II DMEPOS supply code for alcohol or peroxide, billed per pint. It sits in the A-series alongside other antiseptic and wound care supplies, and CMS Policy Article A52464 excludes it from Medicare reimbursement whenever it is billed alongside glucose monitoring equipment.

HCPCS Code A4244: Code details

The code covers both isopropyl alcohol and hydrogen peroxide supplied per pint. Billing staff should note the “per pint” unit is non-negotiable: quantities must be reported in pint units, not ounces or milliliters. Misreporting the unit of measure is a common denial trigger for this code.

2026 Medicare DMEPOS fee schedule for HCPCS code A4244

DMEPOS fee schedule rates for HCPCS code A4244 are updated annually and vary by geographic locality. CMS sets both facility and non-facility rates, and competitive bidding program rules may override the standard fee schedule in applicable areas. Always verify the current rate against the CMS DMEPOS fee schedule for your specific locality before submitting claims.

Where the DMEPOS competitive bidding program applies, contracted suppliers in a competitive bidding area (CBA) must use the competitively bid rate rather than the standard fee schedule. Non-contracted suppliers in a CBA typically cannot bill Medicare for competitively bid items. Confirm your supplier’s competitive bidding status through the CMS supplier directory before billing A4244 in any CBA.

Coverage and reimbursement criteria for A4244

HCPCS code A4244 is explicitly non-covered by Medicare when it is billed in conjunction with glucose monitoring equipment. Per CMS Policy Article A52464 (Glucose Monitor), which accompanies Local Coverage Determination (LCD) L33822, Medicare denies A4244 claims paired with a glucose monitor under reason code GL015: alcohol or peroxide supplies “are not required for the proper functioning of the device.”

The same exclusion applies to the related codes A4245 (alcohol wipes), A4246 (betadine or pHisoHex solution), and A4247 (betadine or iodine swabs/wipes).

This is a policy-based exclusion, not a documentation-dependent coverage decision. Here is why the pairing is denied:

• CMS Policy Article A52464 lists A4244 as non-covered when billed with glucose monitoring equipment, denied under reason code GL015
• The stated rationale is that alcohol or peroxide supplies are not required for the proper functioning of a glucose monitor
• The same exclusion applies to A4245 (alcohol wipes), A4246 (betadine or pHisoHex solution), and A4247 (betadine or iodine swabs/wipes) in this context
• Because this is a policy-based exclusion rather than a medical-necessity review, suppliers should expect an automatic denial, not a documentation request, when A4244 is billed with a glucose monitor
• Coverage for A4244, if it exists, would need to come from a different clinical context or payer, not from pairing it with covered glucose monitoring equipment

State Medicaid programs may apply different coverage criteria, and some commercial payers cover A4244 for wound care or general antiseptic supply outside the glucose monitor context, often billed by primary care practices managing diabetic patients.

If a supplier still wants to bill A4244 alongside a glucose monitor and pass the cost to the beneficiary, an Advance Beneficiary Notice (ABN) and the appropriate liability modifier (see below) are required before delivery. Always verify coverage with the specific payer before billing.

A4244 billing guidelines: Modifiers and claim submission

Accurate billing for HCPCS code A4244 requires attention to three areas: modifier selection, unit reporting, and claim submission sequencing. Errors in any of these areas are the primary cause of denials and audits for this supply code.

Modifier requirements

HCPCS modifiers for DMEPOS claims signal beneficiary status and supplier relationship. The modifiers most commonly referenced for A4244 claims include the following. Verify current applicability with your Medicare Administrative Contractor (MAC), as modifier requirements can vary by jurisdiction and payer policy.

Do not combine GA and GZ on the same claim line: they represent mutually exclusive liability scenarios (ABN obtained vs. not obtained). KL applies only when A4244 is genuinely delivered by mail order rather than picked up at a storefront. Verify current modifier guidance against Noridian Healthcare Solutions, Palmetto GBA, or your applicable MAC before submitting claims.

Documentation requirements

Insufficient documentation is the top reason A4244 claims face post-payment audit. Strong medical documentation workflows protect your practice in the event of a MAC review or Recovery Audit Contractor (RAC) audit. Required documentation includes:

• A valid physician order specifying the supply, quantity, and frequency before delivery
• Medical necessity documentation from the treating practitioner linking the supply to a covered primary DMEPOS item
• Diagnosis support tied to an appropriate ICD-10-CM code (see crosswalk section below)
• Proof of delivery (POD) signed by the beneficiary or authorized representative
• DMEPOS supplier enrollment documentation confirming applicable supplier standards are met

Maintain HIPAA-compliant documentation practices for all DMEPOS records. CMS and MACs require that documentation supporting A4244 claims be retained for a minimum of 7 years and be available for audit within 30 days of a request.

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ICD-10 diagnosis codes commonly billed with HCPCS code A4244

Pairing A4244 with the correct ICD-10-CM diagnosis code is essential for medical necessity support. The diagnosis codes below are those most frequently billed with A4244 on Medicare DMEPOS claims.

These pairings reflect common clinical scenarios, not mandatory requirements: your MAC’s local coverage determination (LCD) governs which diagnosis codes are accepted for coverage purposes. Wound care diagnoses such as M72.6 pair naturally with A4244 claims, so always reference the current CMS ICD-10-CM code set for the applicable fiscal year.

Always confirm ICD-10 code pairings against your MAC’s LCD for glucose monitors and diabetic supplies. Codes that qualify under one LCD may not satisfy another MAC’s requirements in a different jurisdiction. Referencing E11.9 and similar diabetes codes across your patient population helps maintain consistent documentation standards practice-wide.

Related and adjacent HCPCS codes to A4244

Coders working in DMEPOS supply billing frequently need to distinguish A4244 from the adjacent codes in the A42xx range. These codes cover related antiseptic and wound care supplies but differ in form factor, packaging, or intended use.

Selecting the wrong code from this cluster is a common accuracy problem. The same is true across the wider A-series: codes like A4367 are supply-only and are never used to report procedures.

The most common coding error in this range is billing A4244 (liquid per pint) when the actual supply delivered was alcohol wipes in box form; wipes bill under A4245, not A4244.

A second common error is billing A4244 as if it were a covered item when paired with a glucose monitor, since Medicare denies that exact combination outright. Use the AAPC Codify HCPCS lookup or the PGM Billing HCPCS lookup to verify the correct A-series code before submitting any antiseptic supply claim.

Common billing errors and claim denials for A4244

Most A4244 denials trace back to a small set of recurring mistakes. Reviewing these before submission catches the majority of preventable errors.

• Billing A4244 with a covered glucose monitor and expecting Medicare payment. CMS Policy Article A52464 denies this exact pairing under reason code GL015; it is a policy-based exclusion, not a documentation gap.
• Confusing the liquid code with a wipe code. A4244 is per-pint liquid; alcohol wipes bill under A4245. Billing the wrong form factor is a common accuracy error.
• Missing or late physician order. A4244 requires a written order prior to delivery (WOPD); orders signed after the supply was delivered do not satisfy documentation requirements.
• Reporting the wrong unit of measure. Quantities must be reported in pints, not ounces or milliliters.
• Submitting a claim without an ABN when denial is expected. When billing A4244 in a context Medicare is known to deny, use modifier GA with a signed ABN on file, or GZ if no ABN was obtained, rather than submitting the claim as if it were a standard covered item.

How to use HCPCS code A4244 in your practice management system

Billing HCPCS code A4244 accurately depends on how well it is set up inside your practice management software. A well-configured system prevents billing A4244 without the required supporting documentation or pairing it with an incompatible primary DMEPOS item.

The same setup applies whether you’re a DME supplier, a wound care practice, or a wellness practice stocking antiseptic supplies. Here is a practical workflow for DMEPOS suppliers and clinics billing this supply code.

1. Add A4244 to your supply code library. Configure the code with the correct description (“Alcohol or peroxide, per pint”), the pint unit of measure, and the applicable fee schedule rate for your locality. Link it to the relevant payer fee schedules in your system.
2. Set up documentation prompts. Build a workflow trigger that flags A4244 claims for physician order verification before the claim is generated. No order, no claim submission.
3. Flag the glucose-monitor exclusion for Medicare claims. CMS Policy Article A52464 denies A4244 whenever it is billed alongside glucose monitoring equipment (reason code GL015). Build a billing rule that blocks or flags this pairing before submission, and routes it to an ABN/GA-GZ workflow, a different payer, or a non-billable supply category instead of submitting it to Medicare for reimbursement.
4. Configure modifier options. Add the applicable modifier fields to your A4244 claim template. Your billing team should confirm which modifiers apply with your MAC before enabling any modifier as a default.
5. Automate quantity reconciliation. The “per pint” unit must match the quantity documented in the proof of delivery. Build a reconciliation check that compares billed units against delivery records before submission.

Pabau’s claims management software supports DMEPOS supply tracking, documentation workflows, and billing rule configuration that keep A4244 claims compliant.

For practices managing both clinical services and DMEPOS supply billing, EHR integration reduces manual steps and lowers denial rates.

Conclusion

The most expensive A4244 mistakes happen at two points: submitting the code alongside a covered glucose monitor and expecting Medicare to pay it, a pairing CMS Policy Article A52464 explicitly excludes, and billing the liquid code when wipes were actually delivered.

Both errors are preventable with the right billing configuration and documentation workflow in place.

These claims management tools let DMEPOS suppliers and clinical practices configure supply code rules, documentation prompts, and quantity reconciliation checks so A4244 claims go out clean the first time. To see how Pabau handles DMEPOS billing workflows for your practice type, book a demo.

Continue your research

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