Summary & Overview
HCPCS A4671: Disposable Cycler Set for Dialysis
HCPCS Level II code A4671 designates a disposable cycler set used with a cycler dialysis machine, billed per unit. This supply is central to automated peritoneal dialysis (APD) treatment, enabling timed exchanges delivered by a cycler. Nationally, billing for disposable cycler sets is important for managing supply costs and ensuring continuity of home and outpatient dialysis care.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna, UnitedHealthcare, and Medicare. Readers will find an overview of coverage and reimbursement benchmarks across major payers, contextual clinical details about the role of cycler sets in dialysis therapy, and notes on coding and billing considerations where available. The publication also summarizes expected places of service and typical clinical scenarios in which A4671 would be used.
This summary provides a concise reference for billing staff, revenue cycle professionals, and clinical managers seeking to understand the purpose of the code, common sites of service, and which payers are most relevant for negotiations and prior authorization workflows. Data not available in the input is noted where applicable.
Billing Code Overview
HCPCS Level II code A4671 refers to a disposable cycler set used with a cycler dialysis machine, billed per each unit. The service type is durable medical equipment/supplies for dialysis therapy. The typical site of service is home dialysis or outpatient dialysis centers where cycler (automated peritoneal dialysis) machines are used.
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Clinical & Coding Specifications
Clinical Context
A patient with end-stage kidney disease (ESKD) on automated peritoneal dialysis (APD) receives a prescription for a disposable cycler set to be used with a cycler dialysis machine at home. Typical patient: a 62-year-old patient with diabetes mellitus type 2 and ESKD who performs overnight automated peritoneal dialysis using a cycler. The dialysis clinic orders a single-use disposable cycler set (A4671) to be delivered to the patient’s home prior to the next scheduled nightly treatment.
Clinical workflow: The nephrology team documents the APD prescription and supplies in the patient medical record, including tubing set specifics and delivery frequency. A dialysis supply vendor receives the order coded as A4671 for the disposable cycler set, verifies insurance coverage, and coordinates shipment to the patient’s residence. The patient connects the disposable set to the cycler at the start of the overnight session, completes prescribed exchanges, and disposes of the set after use per infection-control instructions. The dialysis clinic documents supply use in the patient’s treatment record and billing system, linking the supply charge and any associated professional services or training provided by a dialysis nurse or home training specialist.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
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