2025 HCPCS Code A4721

Dialysate solution, any concentration of dextrose, fluid volume greater than 999 cc but less than or equal to 1999 cc, for peritoneal dialysis

TAGS: concentration dialysis greater equal volume dialysate fluid peritoneal

Short Description	Dialysat sol fld vol > 999cc
Product Note	0017
HCPCS Action Code	N - No maintenance for this code
HCPCS Coverage Code	D - Special coverage instructions apply
HCPCS Code Added Date	January 01, 2002
HCPCS Action Effective Date	January 01, 2015
HCPCS Pricing Indicator Code	00 - Service not separately priced by part B (e.G., services not covered, bundled, used by part a only, etc.)
HCPCS Type Of Service Code	L - ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)
HCPCS Multiple Pricing Indicator Code	9 - Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established (pricing indicator is '99')
HCPCS Anesthesia Base Unit Quantity	0
HCPCS Coverage Issues Manual Reference Section Number