A4728 – Dialysate solution, non-dextrose containing, 500 ml
HCPCS Level II code · A codes: Transportation, Medical & Surgical Supplies, Miscellaneous & Experimental
HCPCS codeA4728
- Long description
- Dialysate solution, non-dextrose containing, 500 ml
- Short description
- Dialysate solution, non-dex
- Pricing indicator
00Not separately priced by Part B (bundled, not covered or Part A only)- Medicare coverage
CCarrier judgment – coverage decided by the Medicare contractor- BETOS category
P9BDialysis services (Non-Medicare fee schedule)- Added
- January 1, 2004
- Last change
- January 1, 2015 – No change
Frequently asked questions
What is HCPCS code A4728?
A4728 is a HCPCS Level II code for dialysate solution, non-dextrose containing, 500 ml.
Does Medicare cover A4728?
The HCPCS file lists coverage code C: Carrier judgment – coverage decided by the Medicare contractor. Coverage and payment also depend on local coverage determinations and the patient’s plan.
Nearby A codes
- 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
- 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
Source: CMS HCPCS Level II quarterly file, October 2026. Reference only – check payer policy before billing.