A4720 HCPCS - DIALYSATE SOLUTION, ANY CONCENTRATION OF DEXTROSE, FLUID VOLUME GREATER THAN 249 CC, BUT LESS THAN OR EQUAL TO 999 CC, FOR PERITONEAL DIALYSIS

Code Information

HCPCS Code: A4720

Sequence Number: 0010

Short Description: Dialysat sol fld vol > 249cc

Long Description: Dialysate solution, any concentration of dextrose, fluid volume greater than 249 cc, but less than or equal to 999 cc, for peritoneal dialysis

Code Added Date: 1/1/2002

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:
    N/A
    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 A4720
    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 Dialysate solution, any concentration of dextrose, fluid volume greater than 249 cc, but less than or equal to 999 cc, for peritoneal dialysis
    HCPCS Short Description Dialysat sol fld vol > 249cc
    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 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 1/1/2002
    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