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A4723 - Dialys sol fld vol > 2999cc

Navigation: HCPCS Codes > Codes with Prefix: A4
Field Value
HCPCS Code: A4723
Long Description: Dialysate solution, any concentration of dextrose, fluid volume greater than 2999cc but less than or equal to 3999cc, for peritoneal dialysis
Short Description: Dialys sol fld vol > 2999cc
Pricing Indicator 1: 52 (Reasonable charge)
Multiple Pricing Code: A (Not applicable as HCPCS priced under one methodology)
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: 01-01-2002
Action Effective Date: 01-01-2002
Action Code: N (No maintenance for this code)