This section covers a wide variety of medical and surgical supplies, as well as some DME-related supplies and accessories. Medicare generally covers DME-related supplies, accessories, maintenance, and repair under the prosthetic devices provision.

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• A4640

  Replacement pad for use with medically necessary alternating pressure pad owned by patient

• A4641

  Radiopharmaceutical, diagnostic, not otherwise classified

• A4642

  Indium in-111 satumomab pendetide, diagnostic, per study dose, up to 6 millicuries

• A4648

  Tissue marker, implantable, any type, each

• A4649

  Surgical supply; miscellaneous

• A4650

  Implantable radiation dosimeter, each

• A4651

  Calibrated microcapillary tube, each

• A4652

  Microcapillary tube sealant

• A4653

  Peritoneal dialysis catheter anchoring device, belt, each

• A4657

  Syringe, with or without needle, each

• A4660

  Sphygmomanometer/blood pressure apparatus with cuff and stethoscope

• A4663

  Blood pressure cuff only

• A4670

  Automatic blood pressure monitor

• A4671

  Disposable cycler set used with cycler dialysis machine, each

• A4672

  Drainage extension line, sterile, for dialysis, each

• A4673

  Extension line with easy lock connectors, used with dialysis

• A4674

  Chemicals/antiseptics solution used to clean/sterilize dialysis equipment, per 8 oz

• A4680

  Activated carbon filter for hemodialysis, each

• A4690

  Dialyzer (artificial kidneys), all types, all sizes, for hemodialysis, each

• 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

• A4726

  Dialysate solution, any concentration of dextrose, fluid volume greater than 5999 cc, for peritoneal dialysis

• A4728

  Dialysate solution, non-dextrose containing, 500 ml

• A4730

  Fistula cannulation set for hemodialysis, each

• A4736

  Topical anesthetic, for dialysis, per gram

• A4737

  Injectable anesthetic, for dialysis, per 10 ml

• A4740

  Shunt accessory, for hemodialysis, any type, each

• A4750

  Blood tubing, arterial or venous, for hemodialysis, each

• A4755

  Blood tubing, arterial and venous combined, for hemodialysis, each

• A4760

  Dialysate solution test kit, for peritoneal dialysis, any type, each

• A4765

  Dialysate concentrate, powder, additive for peritoneal dialysis, per packet

• A4766

  Dialysate concentrate, solution, additive for peritoneal dialysis, per 10 ml

• A4770

  Blood collection tube, vacuum, for dialysis, per 50

• A4771

  Serum clotting time tube, for dialysis, per 50

• A4772

  Blood glucose test strips, for dialysis, per 50

• A4773

  Occult blood test strips, for dialysis, per 50

• A4774

  Ammonia test strips, for dialysis, per 50

• A4802

  Protamine sulfate, for hemodialysis, per 50 mg

• A4860

  Disposable catheter tips for peritoneal dialysis, per 10

• A4870

  Plumbing and/or electrical work for home hemodialysis equipment

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HCPCS Level II codes and descriptors are approved and maintained jointly by the alpha-numeric editorial panel (consisting of CMS, the Health Insurance Association of America, and the Blue Cross and Blue Shield Association). — Updated 6/3/2026

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