A4765 HCPCS code: Dialysate concentrate, powder, additive for peritoneal dialysis, per packet
A4765 is the HCPCS Level II code for dialysate concentrate, powder, additive for peritoneal dialysis, per packet. Its Medicare coverage code is D (Special coverage instructions apply): Medicare covers it when its national or local coverage criteria are met.
Code details
| Field | Value |
|---|---|
| Section | A codes — Transportation, medical/surgical supplies and miscellaneous |
| Coverage code | D — Special coverage instructions apply |
| Pricing indicator | 00 — Not separately priced by Medicare |
| BETOS category | P9B |
| Added | 1986-01-01 |
| Last action effective | 2015-01-01 |
What changed for A4765
- 1986-01-01: A4765 added to HCPCS Level II
- Next scheduled CMS quarterly update (HCPCS and DMEPOS fee schedule): 2027-01-01
Frequently asked questions
What is HCPCS code A4765?
A4765 is the HCPCS Level II code for dialysate concentrate, powder, additive for peritoneal dialysis, per packet. Short descriptor: "Dialysate conc pow per pack".
Does Medicare cover A4765?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
Related A47 codes
- A4706 — Bicarbonate concentrate, solution, for hemodialysis, per gallon
- A4707 — Bicarbonate concentrate, powder, for hemodialysis, per packet
- A4708 — Acetate concentrate solution, for hemodialysis, per gallon
- A4709 — Acid concentrate, solution, for hemodialysis, per gallon
- A4714 — Treated water (deionized, distilled, or reverse osmosis) for peritoneal dialysis, per gallon
- A4719 — "y set" tubing for peritoneal dialysis
- A4720 — Dialysate solution, any concentration of dextrose, fluid volume greater than 249 cc, but less than or equal to 999 cc, for peritoneal dialysis
- A4721 — Dialysate solution, any concentration of dextrose, fluid volume greater than 999 cc but less than or equal to 1999 cc, for peritoneal dialysis
- A4722 — Dialysate solution, any concentration of dextrose, fluid volume greater than 1999 cc but less than or equal to 2999 cc, for peritoneal dialysis
- A4723 — Dialysate solution, any concentration of dextrose, fluid volume greater than 2999 cc but less than or equal to 3999 cc, for peritoneal dialysis
- A4724 — Dialysate solution, any concentration of dextrose, fluid volume greater than 3999 cc but less than or equal to 4999 cc, for peritoneal dialysis
- A4725 — Dialysate solution, any concentration of dextrose, fluid volume greater than 4999 cc but less than or equal to 5999 cc, for peritoneal dialysis
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Next steps
- Run a reimbursement report for a device billed under A4765
- Watch A4765 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for A4765
Sources: CMS HCPCS Level II release October 2025; CMS DMEPOS fee schedule; CMS NCCI MUE tables; CMS Medicare utilization (physician and DME supplier files); CMS Medicare Coverage Database articles. Fees are Medicare allowables, not commercial rates. Not billing or legal advice.