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A4714 - Treated water per gallon

Navigation: HCPCS Codes > Codes with Prefix: A4
Field Value
HCPCS Code: A4714
Long Description: Treated water (deionized, distilled, or reverse osmosis) for peritoneal dialysis, per gallon
Short Description: Treated water per gallon
Pricing Indicator 1: 52 (Reasonable charge)
Multiple Pricing Code: A (Not applicable as HCPCS priced under one methodology)
Coverage Issues Manual 1: 55-1
MCM Reference Section Number 1: 4270
Statute Number:
Coverage Code: D (Special coverage instructions apply)
ASC Payment Group Code:
Processing Note Number: 0017
Berenson-Eggers Type of Service (BETOS) Code: P9B ()
Type of Service Code 1: L (ESRD supplies (effective 04/95) (renal supplier in the home before 04/95))
Anesthesia Base Unit Quality: 0
Code Added: 01-01-1986
Action Effective Date: 01-01-2002
Action Code: N (No maintenance for this code)