A4722 Dialysate Solution Reimbursement | OpenPayer

Summary & Overview

HCPCS A4722: Dialysate Solution for Peritoneal Dialysis (2000–2999 cc)

HCPCS Level II code A4722 designates a dialysate solution for peritoneal dialysis containing any concentration of dextrose in a fluid volume greater than 1999 cc up to 2999 cc. This supply code is relevant to home-based and outpatient peritoneal dialysis programs and affects billing for consumable dialysis fluids used in exchanges. Nationally, peritoneal dialysis supplies influence payment flows for chronic kidney disease management and home dialysis adoption efforts.

Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication outlines coverage and billing considerations across these major payers, and presents benchmarks and policy context for dialysate supply reimbursement. Readers will find a clinical and billing context for A4722, typical service settings, common modifiers and payer considerations, and guidance on where to locate applicable policy language.

The report also summarizes available benchmarks and recent policy updates affecting peritoneal dialysis supplies, and highlights operational issues such as documentation and claim line reporting. Data not provided in the input are noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareA4722HCPCS Level IIperitoneal dialysisdialysate solutionhome dialysisdialysis suppliesrenal replacement therapymedical billingoutpatient dialysis

Billing Code Overview

HCPCS Level II code A4722 describes a dialysate solution for peritoneal dialysis, specified as any concentration of dextrose in a fluid volume greater than 1999 cc but less than or equal to 2999 cc. This item represents the dialysis fluid supplied for instillation into the peritoneal cavity to facilitate solute and fluid exchange during peritoneal dialysis therapy.

Service Type: Peritoneal dialysis supply (dialysate solution)

Typical Site of Service: Home or outpatient dialysis setting, where peritoneal dialysis exchanges are performed by the patient or a caregiver, or in outpatient clinics that provide peritoneal dialysis services.

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A 58-year-old patient with end-stage renal disease (ESRD) on chronic ambulatory peritoneal dialysis (CAPD) presents for routine home dialysis exchange using a prepackaged dialysis fluid bag containing between 2000 cc and 2999 cc of dialysate with dextrose. The supply is delivered and documented by the dialysis nurse or home health clinician. The typical workflow includes verification of the prescribed dextrose concentration (to achieve ultrafiltration goals), inspection of the fluid bag for integrity and expiration, hand hygiene and aseptic connector technique, drainage of spent dialysate from the peritoneal cavity, instillation of the A4722 volume bag, monitoring dwell time and patient tolerance, and documentation of volume instilled, dwell time, and any complications (e.g., exit-site infection, peritonitis symptoms, or catheter malfunction). The typical site of service is outpatient dialysis units, home dialysis settings, and occasionally inpatient hospital wards when peritoneal dialysis is continued during admission. The patient scenario frequently involves coordination among nephrology, home dialysis nursing, and durable medical equipment suppliers for ongoing provision of A4722 dialysate solution.

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier	Standard reporting when no modifier applies to the service.

HCPCS A4382: Urinary Ostomy Pouch for Faceplate, Heavy Plastic

HCPCS-A4410-OSTOMY-SKIN-BARRIER-FLANGE-EXTENDED-WEAR-LARGE

HCPCS A4410: Ostomy Skin Barrier with Flange, Extended Wear

HCPCS-A4566-SHOULDER-SLING-ABDUCTION-RESTRAINER-PREFABRICATED

HCPCS Level II A4566: Shoulder Sling or Vest with Abduction Restraint

HCPCS-A4217-STERILE-WATER-SALINE-500ML

HCPCS A4217: Sterile Water/Saline, 500 ml

HCPCS-A5500-DIABETIC-DEPTH-INLAY-SHOE-CUSTOM-SUPPLY-FITTING

HCPCS A5500: Diabetic Off-the-Shelf Depth-Inlay Shoe, Custom Supply and Fitting

HCPCS-A4649-SURGICAL-SUPPLY-MISCELLANEOUS

HCPCS Level II A4649: Surgical Supply, Miscellaneous

HCPCS-A6610-GRADIENT-COMPRESSION-STOCKING-BELOW-KNEE-18-30-MMHG-CUSTOM

HCPCS Level II A6610: Below-Knee Custom Gradient Compression Stocking

HCPCS-A7038-DISPOSABLE-FILTER-POSITIVE-AIRWAY-PRESSURE-DEVICE

HCPCS A7038: Disposable Filter for Positive Airway Pressure Device

HCPCS-A4633-REPLACEMENT-ULTRAVIOLET-THERAPY-BULB

HCPCS A4633: Replacement Bulb for Ultraviolet Light Therapy System

HCPCS-A6456-ZINC-PASTE-BANDAGE-3-TO-5-INCH-PER-YARD

HCPCS A6456: Zinc Paste Impregnated Bandage, 3–5 in. Width

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Taxonomy Code	Specialty	Notes
`2080P0201X`	Nephrology	Nephrologists direct dialysis prescriptions, monitor ultrafiltration goals, and manage complications.
`363LP0800X`	Dialysis Facilities (Facility taxonomy placeholder)	Outpatient dialysis units provide supplies and perform exchanges; listed as common site-based specialty.
`3336S0200X`	Home Health Agency	Home health nurses train patients for CAPD and supply management; commonly involved in home exchanges.
`363A00000X`	Vascular Surgery / Access Management	Surgeons manage peritoneal catheter placement or revisions associated with dialysis delivery.
`207Q00000X`	Internal Medicine	Hospitalists or internists may oversee inpatient peritoneal dialysis management and coordinate care.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`N18.6`	End stage renal disease	Primary indication for chronic peritoneal dialysis and routine use of `A4722` dialysate bags.
`N18.5`	Chronic kidney disease, stage 5	Advanced CKD patients transitioning to dialysis modalities including peritoneal dialysis.
`Z99.2`	Dependence on renal dialysis	Documentation of ongoing dialysis dependence when billing for dialysate supplies.
`T85.698A`	Other mechanical complication of other specified implanted devices, implants and grafts, initial encounter	Used for peritoneal catheter malfunction requiring intervention during dialysis care.
`K65.9`	Peritonitis, unspecified	Peritonitis is a potential complication of peritoneal dialysis; may alter dialysis fluid selection or interrupt exchanges.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`49422`	Peritoneal dialysis, catheter placement, percutaneous, initial placement	Catheter insertion required before ambulatory peritoneal dialysis exchanges with `A4722` solutions.
`49423`	Peritoneal dialysis catheter placement, open surgical technique	Alternative surgical technique for catheter placement preceding ongoing dialysate bag use.
`90945`	Dialysis procedure other than hemodialysis, peritoneal dialysis training and management, initial 1–2 hours	Training sessions for patient/family to perform exchanges with `A4722` volume bags.
`90947`	Peritoneal dialysis training and management, subsequent	Ongoing management visits and training reinforcement for CAPD exchanges using `A4722`.
`99070`	Supplies and materials (except standardized office supplies) provided by physician over and above those usually included	Occasionally used for noncovered supplies or special equipment associated with peritoneal dialysis but subject to payer rules.
`99600`	Unlisted home infusion/administration service	Used when specific administration or home infusion services related to complex peritoneal dialysis care are not described by other CPT codes.

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