Summary & Overview
HCPCS Level II A4690: Dialyzer (Artificial Kidney) for Hemodialysis
HCPCS Level II code A4690 identifies a single dialyzer (artificial kidney) used in hemodialysis. Dialyzers are critical disposable components of hemodialysis treatment, directly affecting treatment delivery, patient safety, and supply costs across the dialysis care continuum. National attention on A4690 stems from its routine, high-volume use in outpatient dialysis centers and hospital outpatient departments and its influence on per-treatment supply expenditures.
Key payers considered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for dialyzer use, common sites of service, and the role of the device in hemodialysis workflows. The publication summarizes benchmarking data and reimbursement patterns where available, outlines relevant policy or coverage considerations at a national level, and highlights coding distinctions that affect billing and documentation. Practical implications for providers and billing staff are described in neutral terms to support accurate claim submission and administrative planning.
Data not available in the input is noted where applicable.
Billing Code Overview
HCPCS Level II code A4690 denotes a dialyzer (artificial kidney), all types, all sizes, for hemodialysis, each. This supply is used during hemodialysis treatments to filter a patient’s blood and perform the functions of a failing kidney.
Service Type: Durable medical/supplies for hemodialysis
Typical Site of Service: Outpatient dialysis centers and hospital outpatient departments
Clinical & Coding Specifications
Clinical Context
A 62-year-old patient with end-stage renal disease (ESRD) receives maintenance in-center hemodialysis three times per week. At each dialysis session the dialysis unit supplies a single-use A4690 dialyzer (artificial kidney) appropriate for the patient’s prescribed blood and dialysate flow rates and membrane characteristics. The clinical workflow begins with pre-dialysis nursing assessment, verification of vascular access (arteriovenous fistula or central venous catheter), and prescription review by the nephrology team. The dialysis machine is primed, the selected A4690 dialyzer is connected in the extracorporeal circuit, and anticoagulation is administered per protocol. Dialysis is delivered for the prescribed duration while nursing monitors hemodynamics and machine alarms. After treatment, the dialyzer is discarded per single-use policy or handled according to reprocessing protocols if an alternative reusable dialyzer were applicable. Documentation includes dialyzer A4690 supply usage, dialyzer lot number when required, start and stop times, blood flow, dialysate composition, anticoagulant dosing, and any complications or procedure modifications.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier | Standard reporting when no specific modifier applies to the item |
22 | Increased procedural services | When substantially greater resources are required for dialysis delivery or equipment handling beyond typical use (rare for supply code)
23 | Unusual anesthesia | Not generally applicable to A4690; would be used only if unusual anesthesia was provided during a procedure involving dialysis
52 | Reduced services | When dialysis session or supply use is partially reduced compared with full service
53 | Discontinued procedure | When dialysis cannot be completed and the dialyzer was unused or procedure terminated
54 | Surgical care only | Not typically applicable to this supply-only code
55 | Postoperative management only | Not typically applicable to this supply-only code
62 | Two surgeons | Rarely applicable; not typical for dialysis supply billing
78 | Unplanned return to the operating/procedure room | Not typically applicable to dialysis supplies
80 | Assistant surgeon | Not applicable to supply code
82 | Assistant surgeon (when qualified resident not available) | Not applicable to supply code
AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | Not applicable to supply code
NU | New equipment | Use if the dialyzer is billed as new/unused equipment when payor requires this modifier
QK | Medical direction of two, three, or four concurrent anesthesia procedures | Not applicable to supply code
QX | Qualified nonphysician anesthetist with medical direction | Not applicable to supply code
| Taxonomy Code | Specialty | Notes |
|---|---|---|
2080P0207X | Nephrology | Nephrologists prescribe dialysis modalities and dialyzer selection |
363L00000X | Dialysis Facility | Provides and bills for dialysis supplies including A4690
174400000X | Registered Nurse | Performs dialysis setup, monitoring, and documentation
186E00000X | Supply Chain/Medical Equipment Supplier | Manages procurement and billing of disposable dialyzers
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
N18.6 | End-stage renal disease | Primary indication for chronic hemodialysis using A4690 dialyzers |
N18.5 | Chronic kidney disease, stage 5 | Severe CKD stage preceding or overlapping ESRD; often managed with hemodialysis and A4690 use
Z99.2 | Dependence on renal dialysis | Indicates ongoing dialysis dependence; documents need for recurring A4690 dialyzers
T82.8XXA | Mechanical complication of other vascular device, implant and graft, initial encounter | Relevant when dialysis access complications necessitate changes in dialysis delivery where A4690 is used
I77.1 | Stricture of artery | May affect vascular access adequacy and dialysis scheduling using A4690 dialyzers
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
90935 | Hemodialysis procedure with single evaluation by a physician for existing vascular access | Billed for the dialysis treatment event when a physician performs the evaluation; occurs alongside A4690 supply use |
90937 | Hemodialysis procedure requiring repeated evaluations, for established patient | Used for longer or repeated physician involvement during dialysis sessions where A4690 is used
90945 | Dialysis procedural services for a new patient with physician evaluation | Applied when initiating dialysis therapy for a new patient using the A4690 dialyzer
36561 | Insertion of tunneled central venous catheter, for dialysis | Performed prior to hemodialysis for patients without permanent access; supports subsequent use of A4690 dialyzers
36831 | Revision of dialysis access, open; creation of arteriovenous fistula or graft | Surgical access procedures that affect ongoing hemodialysis treatments and the use of A4690 dialyzers