| HCPCS Code: |
A4714 |
| Long Description: |
Treated water (deionized, distilled, or reverse osmosis) for peritoneal dialysis, per gallon |
| Short Description: |
Treated water per gallon |
| Pricing Indicator 1: |
52 (Reasonable charge) |
| Multiple Pricing Code: |
A (Not applicable as HCPCS priced under one methodology) |
| Coverage Issues Manual 1: |
55-1 |
| MCM Reference Section Number 1: |
4270 |
| Statute Number: |
|
| Coverage Code: |
D (Special coverage instructions apply) |
| ASC Payment Group Code: |
|
| Processing Note Number: |
0017 |
| Berenson-Eggers Type of Service (BETOS) Code: |
P9B () |
| Type of Service Code 1: |
L (ESRD supplies (effective 04/95) (renal supplier in the home before 04/95)) |
| Anesthesia Base Unit Quality: |
0 |
| Code Added: |
01-01-1986 |
| Action Effective Date: |
01-01-2002 |
| Action Code: |
N (No maintenance for this code) |
