A4765 – Dialysate concentrate, powder, additive for peritoneal dialysis, per packet

HCPCS Level II code · A codes: Transportation, Medical & Surgical Supplies, Miscellaneous & Experimental

Active code Special coverage instructions apply

HCPCS codeA4765
Long description
Dialysate concentrate, powder, additive for peritoneal dialysis, per packet
Short description
Dialysate conc pow per pack
Pricing indicator
00 Not separately priced by Part B (bundled, not covered or Part A only)
Medicare coverage
D Special coverage instructions apply
BETOS category
P9B Dialysis services (Non-Medicare fee schedule)
Added
January 1, 1986
Last change
January 1, 2015 – No change

Frequently asked questions

What is HCPCS code A4765?

A4765 is a HCPCS Level II code for dialysate concentrate, powder, additive for peritoneal dialysis, per packet.

Does Medicare cover A4765?

The HCPCS file lists coverage code D: Special coverage instructions apply. Coverage and payment also depend on local coverage determinations and the patient’s plan.

Nearby A codes

Source: CMS HCPCS Level II quarterly file, October 2026. Reference only – check payer policy before billing.