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

Short Description	Dialysat sol fld vol > 999cc
Product Note	0017
HCPCS Coverage Code	D - Special coverage instructions apply
HCPCS Action Code	N - No maintenance for this code
HCPCS Action Effective Date	January 01, 2015
HCPCS Code Added Date	January 01, 2002
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 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
HCPCS Type Of Service Code	L - ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)
HCPCS Anesthesia Base Unit Quantity	0