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    v1.0.28
    OpenPayerBilling CodesMedical And Surgical SuppliesHCPCS hcpcs-a4737-injectable-anesthetic-dialysis-10ml
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    HCPCS Level II A4737: Injectable Anesthetic for Dialysis, per 10 ml

    HCPCS Level II code A4737 designates an injectable anesthetic supplied for dialysis procedures, described as medication provided per 10 ml; the service type is injectable anesthetic administration/supply and the typical site of service is dialysis clinic or outpatient dialysis setting where local or regional anesthetic is needed for vascular access or related procedures.

    For related coverage guidance, see recent payer policy updates: Salivary Hormone Testing, Bone Turnover Markers Testing, Parathyroid Hormone, Phosphorus, Calcium, and Magnesium Testing.

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    Clinical & Coding Specifications

    Clinical Context

    A typical patient is a 58-year-old with end-stage renal disease (ESRD) receiving maintenance hemodialysis via a tunneled central venous catheter or arteriovenous fistula. During dialysis, the patient reports pain or requires local anesthetic for catheter insertion, replacement, or tunneled catheter-site dressing changes. The dialysis nurse or nephrology physician prepares an injectable anesthetic in 10 ml vials (A4737) to provide local infiltration at the vascular access site prior to needling, minor procedures, or catheter manipulation. The clinical workflow: the patient is assessed for pain and allergies, informed consent is confirmed for topical/local anesthetic use, standard infection control and monitoring are applied, the injectable anesthetic is drawn and labeled, local skin antisepsis is performed, and the anesthetic is infiltrated at the access site. Vital signs and access function are observed during and after the procedure; documentation includes indication, medication name and amount (per 10 ml unit A4737), lot number, expiration, site, and patient response.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    36620Arterial catheterization or cannulation for exchange, replacement, or removal of indwelling catheter; without venous catheterizationMay be performed when vascular access requires catheter manipulation and local anesthetic (A4737) is used for infiltration.
    36831Arteriovenous fistula creation, with anastomosis of artery to veinSurgical creation of access where injectable local anesthetic units may be used for local infiltration during the procedure.
    36818Thrombolysis, open, salvage of thrombosed dialysis accessPerformed when dialysis access thrombosis requires intervention; local anesthesia may be used for parts of the procedure.
    36556Intermittent hemodialysis, dialysis needle or catheter placementLocal anesthetic (A4737) commonly used for vascular access needling or catheter insertions associated with dialysis sessions.
    49900Unlisted procedure, abdomen, laparoscopy; used only when specific code not available (example for tunneled catheter placement)Occasionally used if a specific CPT for a novel access placement is required; local anesthetic units documented separately.

    Related Modifiers

    7 rows

    ModifierDescriptionWhen to Use
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    23Modifier -23 (Unusual Anesthesia) is used on anesthesia service CPT codes when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia…- Use modifier -23 only on anesthesia CPT codes (00100–01999) when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia because of…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    80CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…
    82Modifier 82 is appended to a surgical CPT code to indicate that an attending physician acted as an assistant because a qualified resident surgeon was unavailable. In teaching hospitals it documents…- When to use: Append modifier 82 in teaching-hospital settings to indicate a physician served as an assistant surgeon because a qualified resident surgeon was unavailable (includes situations where…

    Related Provider Taxonomies

    8 rows

    Taxonomy CodeSpecialtyNotes
    363L00000XNurse Practitioner(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision mak…
    207P00000XEmergency Medicine PhysicianAn emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospit…
    207Q00000XFamily Medicine PhysicianFamily Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadt…
    207K00000XAllergy & Immunology PhysicianAn allergist-immunologist is trained in evaluation, physical and laboratory diagnosis, and management of disorders involving the immune system. Select…
    324500000XSubstance Abuse Rehabilitation FacilityA facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the tre…
    204E00000XOral & Maxillofacial Surgery (D.M.D.)Oral and maxillofacial surgeons are trained to recognize and treat a wide spectrum of diseases, injuries and defects in the head, neck, face, jaws and…
    364SC1501XCommunity Health/Public Health Clinical Nurse SpecialistPhysician Assistants & Advanced Practice Nursing Providers · Clinical Nurse Specialist
    261QP0904XFederal Public Health Clinic/CenterAmbulatory Health Care Facilities · Clinic/Center

    Related ICD-10-CM Codes

    25 rows

    ICD-10-CM CodeDescription
    B18.2Chronic viral hepatitis C
    E10.21Type 1 diabetes mellitus with diabetic nephropathy
    E11.21Type 2 diabetes mellitus with diabetic nephropathy
    E86.0Dehydration
    E87.1Hypo-osmolality and hyponatremia
    I12.9Hypertensive chronic kidney disease with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease
    I13.10Hypertensive heart and chronic kidney disease without heart failure, with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease
    I50.9Heart failure, unspecified
    I95.9Hypotension, unspecified
    K74.60Unspecified cirrhosis of liver

    Showing 1–10 of 25

    Related Payer Policy Updates

    Specialty: Endocrinology1 / 3

    5 rows

    PolicyPayerEffective Date
    Salivary Hormone TestingOscar Health2026-10-01
    Bone Turnover Markers TestingOscar Health2026-10-01
    Parathyroid Hormone, Phosphorus, Calcium, and Magnesium TestingOscar Health2026-10-01
    Testosterone — Coverage Criteria for Measurement and MonitoringOscar Health2026-10-01
    Thyroid Disease TestingOscar Health2026-10-01

    Related Codes

    HCPCS-A4206-STERILE-SYRINGE-1CC-NEEDLE

    HCPCS A4206: Syringe with Needle, 1 cc or Less, Sterile

    HCPCS-A4207-STERILE-2CC-SYRINGE-WITH-NEEDLE

    HCPCS Level II A4207: Syringe with Needle, Sterile 2 cc

    HCPCS-A4208-STERILE-3CC-SYRINGE-WITH-NEEDLE

    HCPCS Level II A4208: Syringe with Needle, Sterile 3 cc

    HCPCS-A4209-STERILE-SYRINGE-WITH-NEEDLE-5CC-OR-GREATER

    HCPCS Level II A4209: Syringe with Needle, Sterile 5 cc or Greater

    HCPCS-A4210-NEEDLE-FREE-INJECTION-DEVICE

    HCPCS Level II A4210: Needle-free Injection Device, Each

    HCPCS-A4211-SUPPLIES-SELF-ADMINISTERED-INJECTIONS

    HCPCS Level II A4211: Supplies for Self-Administered Injections

    HCPCS-A4212-NON-CORING-NEEDLE-STYLET-CATHETER-ACCESS-SUPPLY

    HCPCS Level II A4212: Non-coring Needle or Stylet with/without Catheter

    HCPCS-A4213-STERILE-SYRINGE-20CC-OR-GREATER

    HCPCS Level II A4213: Syringe, Sterile, 20 cc or Greater, Each

    HCPCS-A4215-STERILE-NEEDLE-SINGLE-EACH

    HCPCS Level II A4215: Needle, Sterile, Any Size

    HCPCS-A4216-STERILE-DILUENT-FLUSH-10ML

    HCPCS Level II A4216: Sterile Diluent/Flush, 10 ml

    Showing 1–10 of 633

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    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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