HCPCS Range Dialysis Equipment and Supplies

• 1 Peritoneal dialysis catheter anchoring device, belt, each ( A4653 )

• 2 Syringe, with or without needle, each ( A4657 )

• 3 Sphygmomanometer/blood pressure apparatus with cuff and stethoscope ( A4660 )

• 4 Blood pressure cuff only ( A4663 )

• 5 Automatic blood pressure monitor ( A4670 )

• 6 Disposable cycler set used with cycler dialysis machine, each ( A4671 )

• 7 Drainage extension line, sterile, for dialysis, each ( A4672 )

• 8 Extension line with easy lock connectors, used with dialysis ( A4673 )

• 9 Chemicals/antiseptics solution used to clean/sterilize dialysis equipment, per 8 oz ( A4674 )

• 10 Activated carbon filter for hemodialysis, each ( A4680 )

• 11 Dialyzer (artificial kidneys), all types, all sizes, for hemodialysis, each ( A4690 )

• 12 Bicarbonate concentrate, solution, for hemodialysis, per gallon ( A4706 )

• 13 Bicarbonate concentrate, powder, for hemodialysis, per packet ( A4707 )

• 14 Acetate concentrate solution, for hemodialysis, per gallon ( A4708 )

• 15 Acid concentrate, solution, for hemodialysis, per gallon ( A4709 )

• 16 Treated water (deionized, distilled, or reverse osmosis) for peritoneal dialysis, per gallon ( A4714 )

• 17 "Y set" tubing for peritoneal dialysis ( A4719 )

• 18 Dialysate solution, any concentration of dextrose, fluid volume greater than 249 cc, but less than or equal to 999 cc, for peritoneal dialysis ( A4720 )

• 19 Dialysate solution, any concentration of dextrose, fluid volume greater than 999 cc but less than or equal to 1999 cc, for peritoneal dialysis ( A4721 )

• 20 Dialysate solution, any concentration of dextrose, fluid volume greater than 1999 cc but less than or equal to 2999 cc, for peritoneal dialysis ( A4722 )

• 21 Dialysate solution, any concentration of dextrose, fluid volume greater than 2999 cc but less than or equal to 3999 cc, for peritoneal dialysis ( A4723 )

• 22 Dialysate solution, any concentration of dextrose, fluid volume greater than 3999 cc but less than or equal to 4999 cc, for peritoneal dialysis ( A4724 )

• 23 Dialysate solution, any concentration of dextrose, fluid volume greater than 4999 cc but less than or equal to 5999 cc, for peritoneal dialysis ( A4725 )

• 24 Dialysate solution, any concentration of dextrose, fluid volume greater than 5999 cc, for peritoneal dialysis ( A4726 )

• 25 Dialysate solution, non-dextrose containing, 500 ml ( A4728 )

• 26 Fistula cannulation set for hemodialysis, each ( A4730 )

• 27 Topical anesthetic, for dialysis, per gram ( A4736 )

• 28 Injectable anesthetic, for dialysis, per 10 ml ( A4737 )

• 29 Shunt accessory, for hemodialysis, any type, each ( A4740 )

• 30 Blood tubing, arterial or venous, for hemodialysis, each ( A4750 )

• 31 Blood tubing, arterial and venous combined, for hemodialysis, each ( A4755 )

• 32 Dialysate solution test kit, for peritoneal dialysis, any type, each ( A4760 )

• 33 Dialysate concentrate, powder, additive for peritoneal dialysis, per packet ( A4765 )

• 34 Dialysate concentrate, solution, additive for peritoneal dialysis, per 10 ml ( A4766 )

• 35 Blood collection tube, vacuum, for dialysis, per 50 ( A4770 )

• 36 Serum clotting time tube, for dialysis, per 50 ( A4771 )

• 37 Blood glucose test strips, for dialysis, per 50 ( A4772 )

• 38 Occult blood test strips, for dialysis, per 50 ( A4773 )

• 39 Ammonia test strips, for dialysis, per 50 ( A4774 )

• 40 Protamine sulfate, for hemodialysis, per 50 mg ( A4802 )

• 41 Disposable catheter tips for peritoneal dialysis, per 10 ( A4860 )

• 42 Plumbing and/or electrical work for home hemodialysis equipment ( A4870 )

• 43 Contracts, repair and maintenance, for hemodialysis equipment ( A4890 )

• 44 Drain bag/bottle, for dialysis, each ( A4911 )

• 45 Miscellaneous dialysis supplies, not otherwise specified ( A4913 )

• 46 Venous pressure clamp, for hemodialysis, each ( A4918 )

• 47 Gloves, non-sterile, per 100 ( A4927 )

• 48 Surgical mask, per 20 ( A4928 )

• 49 Tourniquet for dialysis, each ( A4929 )

• 50 Gloves, sterile, per pair ( A4930 )

• 51 Oral thermometer, reusable, any type, each ( A4931 )

• 52 Rectal thermometer, reusable, any type, each ( A4932 )