Table of content for "Dialys sol fld vol > 1999cc" (HCPCS A4722)
General information on the “A4722” code
HCPCS Code: A4722
Long Description: Dialysate solution, any concentration of dextrose, fluid volume greater than 1999 cc but less than or equal to 2999 cc, for peritoneal dialysis
Short Description: Dialys sol fld vol > 1999cc
Original information is taken from A4722 page
Pricing indicators
Pricing Indicator Code 1: 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')
Certification and additional reference information
Coverage
Coverage: D – Special coverage instructions apply
Type of service
Processing Note Number: 0017
Berenson-Eggers Type of Service (BETOS): P9B – Dialysis services (non-medicare fee schedule)
Type Of Service 1: L – ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)
Misc information
Anesthesia Base Unit Quantity: 0
Code Added Date: 20020101
Code Effective Date: 20150101
Action Code: N – No maintenance for this code