A4722

Short Description

• Dialys sol fld vol > 1999cc

Procedure Note

• 0017 = SEE INTERMEDIARY MANUAL SECTION 3170.5 FOR COVERAGE INSTRUCTIONS PERTAINING TO E1510 – E1600, E1620, E1630 – E1699, A4650 – A4663, A4690, A4712, A4730 – A4870, A4890 – A4927.

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 Medicare Carriers Manual Reference Section Number

• 4270

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