Update to HCPCS Code A4252

Attention Durable Medical Equipment (DME) Providers

Per Clinical Coverage Policy 5A-3, Nursing Equipment and Supplies on the NC Medicaid website at https://medicaid.ncdhhs.gov/providers/programs-services/medical/durable-medical-equipment, HCPCS code A4252 (blood ketone test or reagent strip, each) has a quantity limitation of 100 test strips per month. Considering the national description of A4252 refers to each test strip, DME providers are reminded to submit their claims with the number of test strips supplied to the beneficiary not the number of boxes of test strips. One unit of A4252 equals one test strip, not one box of test strips. For example, if a beneficiary requires 50 blood ketone test strips per month, then the provider should supply 5 boxes of 10 test strips and submit their claim for 50 units (1 unit = 1 test strip).

HCPCS code A4252 is manually priced. Therefore, DME providers are also reminded that an invoice must be submitted along with their claim to NCTracks.