A4766 Dialysate Concentrate HCPCS Reimbursement

HCPCS Level II code A4766 denotes dialysate concentrate used as an additive for peritoneal dialysis, billed per 10 ml. This supply-level code is relevant to facilities and clinicians who manage peritoneal dialysis supplies for outpatient clinics, home dialysis programs, and hospital outpatient departments. Nationally, accurate coding of dialysis solutions and additives affects billing for chronic kidney disease care and the supply chains that support home-based dialysis modalities.

Key payers typically included in coverage and benchmarking for this code are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the code’s clinical role in peritoneal dialysis supply management, payer coverage context, common billing modifiers (listed separately), and where this item fits within service lines for dialysis treatment. The publication also outlines available benchmark categories and notes when data elements are not available.

This summary provides a concise reference for revenue cycle teams, supply chain managers, and clinical program leaders seeking to understand the purpose of A4766, the typical settings where it is used, and which major payers are most relevant for coverage and billing considerations.

Billing Code Overview

HCPCS Level II code A4766 describes dialysate concentrate, solution, additive for peritoneal dialysis, per 10 ml. This item is a liquid concentrate used to prepare or adjust dialysate for peritoneal dialysis treatments. Service type: dialysis supply / dialysis solution additive. Typical site of service: outpatient dialysis clinics, home peritoneal dialysis settings, and hospital outpatient departments.

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Clinical Context

A patient with end-stage kidney disease on chronic peritoneal dialysis presents to the outpatient dialysis clinic for routine exchange management. The clinician orders dialysate additives or peritoneal dialysis solution concentrates to correct electrolyte imbalances and optimize ultrafiltration. A typical scenario is a 62-year-old patient with diabetic nephropathy and refractory volume overload who requires adjustment of peritoneal dialysis prescription: the nurse mixes and dispenses a specific A4766 dialysate concentrate additive (per 10 ml) at the clinic pharmacy to create the prescribed dialysis solution for cycler or manual exchanges. Documentation includes the prescription for the specific concentrate volume, lot number, date/time of dispensing, route (intraperitoneal via PD catheter), and the indication (e.g., sodium correction, bicarbonate replacement, antibiotic admixture when applicable). Billing is submitted for the dispensed A4766 units in addition to any PD supply HCPCS codes and applicable procedure codes for training or cycler setup when performed at the same visit.

Coding Specifications

Modifier	Description	When to Use
`52`	Reduced services	Use when a dialysate concentrate is provided in a reduced quantity or scope compared with typical dispensing.

Taxonomy Code	Specialty	Notes
`2080P0800X`	Nephrology	Primary specialty managing peritoneal dialysis prescriptions and dialysate selection.
`363L00000X`	Dialysis Facility	Facility-based providers dispensing PD supplies and concentrates.
`167V00000X`	Surgeon - General Surgery	Surgeons performing PD catheter placement or revision associated with dialysis solution changes.
`341600000X`	Nurse Practitioner	APPs who manage PD patients, adjust prescriptions, and dispense concentrates.
`3336C0003X`	Clinical Nurse Specialist (Nephrology)	Specialist nurses involved in PD training, mixing, and dispensing of dialysate concentrates.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`N18.6`	End stage renal disease	Primary indication for chronic peritoneal dialysis and use of dialysate concentrates.
`N18.4`	Chronic kidney disease, stage 4 (severe)	Patients nearing ESRD who may require adjustments to PD prescriptions and concentrates.
`E10.21`	Type 1 diabetes mellitus with diabetic nephropathy	Common etiology of kidney failure necessitating PD and dialysate management.
`E11.21`	Type 2 diabetes mellitus with diabetic nephropathy	Common cause of ESRD treated with peritoneal dialysis and dialysate additives.
`I10`	Essential (primary) hypertension	Frequently coexists with CKD and influences PD fluid composition decisions.
`R60.0`	Localized edema	Clinical sign that may prompt changes in dialysate osmolarity or exchange volumes using concentrates.
`E87.5`	Hyperkalemia	Electrolyte abnormality that may require specific dialysate composition adjustments using concentrate additives.
`E87.6`	Hypokalemia	Electrolyte abnormality that may require dialysate potassium supplementation via concentrates.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`90945`	Dialysis procedure other than hemodialysis, peritoneal dialysis training (includes supplies and equipment)	Billed for initial peritoneal dialysis training sessions during which dialysate concentrates such as `A4766` are demonstrated and dispensed.
`90947`	Peritoneal dialysis, including initial training and periodic re-evaluation	Used for ongoing peritoneal dialysis management encounters where dialysate prescription and concentrates are adjusted.
`49422`	Replacement, revision, or repair of peritoneal dialysis catheter, open; with subcutaneous port or modification	Surgical code for catheter procedures where intraoperative decisions about dialysate use or additives may be required.
`96365`	Intravenous infusion, therapeutic, prophylactic, or diagnostic; initial, up to 1 hour	When antibiotics or additives are administered intraperitoneally under infusion protocols and IV infusion coding is used for associated systemic therapy.
`99070`	Supplies and materials (except spectacles), provided by the physician over and above those usually included with the office visit	Used to report additional supplies like specialized dialysate concentrates when payer allows separate billing alongside the visit.

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Summary & Overview

HCPCS Level II A4766: Dialysate Concentrate for Peritoneal Dialysis, per 10 ml