A4714 HCPCS - TREATED WATER (DEIONIZED, DISTILLED, OR REVERSE OSMOSIS) FOR PERITONEAL DIALYSIS, PER GALLON

Code Information

HCPCS Code: A4714

Sequence Number: 0010

Short Description: Treated water per gallon

Long Description: Treated water (deionized, distilled, or reverse osmosis) for peritoneal dialysis, per gallon

Code Added Date: 1/1/1986

Action Code: N - No maintenance for this code

Action Effective Date: 1/1/2015

Classification: Transportation, Medical & Surgical Supplies, Miscellaneous & Experimental

Coding System: HCPCS

Code Type

Berenson-Eggers Type Of Service Code: P9B - Dialysis services (non-medicare fee schedule)
Type Of Service Code:
  • L - ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)

Billing Information

Pricing Indicator Code:
  • 00 - Service not separately priced by part B (e.G., services not covered, bundled, used by part a only, etc.)
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')
Coverage Issues Manual Reference Section Number:
  • 55-1
Medicare Carriers Manual Reference Section Number:
  • 4270
Coverage Code: D - Special coverage instructions apply

HCPCS Record

Field Name Field Value
Healthcare Common Procedure Coding System Code A4714
HCPCS Sequence Number 0010
HCPCS Record Identification Code 3 - First line of procedure record also contains detail information in positions 92-275
HCPCS Long Description Treated water (deionized, distilled, or reverse osmosis) for peritoneal dialysis, per gallon
HCPCS Short Description Treated water per gallon
HCPCS Pricing Indicator Code 1 00 - Service not separately priced by part B (e.G., services not covered, bundled, used by part a only, etc.)
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 Coverage Issues Manual Reference Section Number 1 55-1
HCPCS Medicare Carriers Manual Reference Section Number 1 4270
HCPCS Coverage Code D - Special coverage instructions apply
HCPCS Processing Note Number 0017
HCPCS Berenson-Eggers Type Of Service Code P9B - Dialysis services (non-medicare fee schedule)
HCPCS Type Of Service Code 1 L - ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)
HCPCS Anesthesia Base Unit Quantity 0
HCPCS Code Added Date 1/1/1986
HCPCS Action Effective Date 1/1/2015
HCPCS Action Code N - No maintenance for this code

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This page was last updated on: 1/1/2018