A4728 — Dialysate solution, non-dextrose containing, 500 ml
A4728 is a HCPCS Level II code for dialysate solution, non-dextrose containing, 500 ml. It belongs to the Transportation, Medical & Surgical Supplies, Administrative section. Whether Medicare pays it depends on the coverage rule below.
Medicare coverage: Carrier judgment
Coverage is decided by your Medicare contractor, not by national policy. Whether this is paid depends on the LCD for your jurisdiction and on what the documentation supports.
From the coverage field of the CMS Alpha-Numeric HCPCS File, release 2026Q3-Jul. This states Medicare’s position on the code, not on your particular claim.
Physician fee schedule statusX
Statutory exclusion. The item or service is not within the statutory definition of 'physician services', so the fee schedule never pays it.
Global period: XXX
Want the dollar amount for your locality? The fee calculator applies your GPCI and the current conversion factor.
Medically Unlikely Edits — units per day
The most units of A4728 Medicare will pay on one date of service. Bill more on a single line and it is denied. The limit is not the same in every setting, so the row that matters is the one matching the claim you are building.
- practitioner
- 0 — never payable MAI 3 — Date of Service Edit: Clinical · CMS Policy
- outpatient
- 0 — never payable MAI 3 — Date of Service Edit: Clinical · CMS Policy
- DME supplier
- 0 — never payable MAI 3 — Date of Service Edit: Clinical · CMS Policy
The adjudication indicator decides whether exceeding the limit is worth appealing at all: MAI 1 is a line edit you can support with documentation, MAI 3 is a date-of-service edit that is also appealable, and MAI 2 is absolute — no documentation overrides it. CMS MUE 2026Q3.
The CMS record for A4728
- Long descriptor
- Dialysate solution, non-dextrose containing, 500 ml
- Short descriptor
- Dialysate solution, non-dex
- Added
- January 1, 2004
- BETOS
- P9B
- Pricing indicator
- 00 — Not priced by Part B
The official wording. This is what the code means.
CMS's 28-character form, which is what shows up on a remittance advice.
When CMS introduced the code.
Berenson-Eggers Type of Service — CMS's own analytic grouping.
Service not separately priced by Part B — not covered, bundled into another service, or used by Part A only.
Codes adjacent to A4728
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If A4728 is not quite right, the correct code is very often within a few positions of it.
- A4719"y set" tubing for peritoneal dialysis
- A4720Dialysate solution, any concentration of dextrose, fluid volume greater than 249 cc, but less than or equal to 999 cc, for peritoneal dialysis
- A4721Dialysate solution, any concentration of dextrose, fluid volume greater than 999 cc but less than or equal to 1999 cc, for peritoneal dialysis
- A4722Dialysate solution, any concentration of dextrose, fluid volume greater than 1999 cc but less than or equal to 2999 cc, for peritoneal dialysis
- A4723Dialysate solution, any concentration of dextrose, fluid volume greater than 2999 cc but less than or equal to 3999 cc, for peritoneal dialysis
- A4724Dialysate solution, any concentration of dextrose, fluid volume greater than 3999 cc but less than or equal to 4999 cc, for peritoneal dialysis
- A4725Dialysate solution, any concentration of dextrose, fluid volume greater than 4999 cc but less than or equal to 5999 cc, for peritoneal dialysis
- A4726Dialysate solution, any concentration of dextrose, fluid volume greater than 5999 cc, for peritoneal dialysis
- A4730Fistula cannulation set for hemodialysis, each
- A4736Topical anesthetic, for dialysis, per gram
- A4737Injectable anesthetic, for dialysis, per 10 ml
- A4740Shunt accessory, for hemodialysis, any type, each
- A4750Blood tubing, arterial or venous, for hemodialysis, each
- A4755Blood tubing, arterial and venous combined, for hemodialysis, each
- A4760Dialysate solution test kit, for peritoneal dialysis, any type, each
- A4765Dialysate concentrate, powder, additive for peritoneal dialysis, per packet
Questions about A4728
What is HCPCS code A4728?
A4728 is a HCPCS Level II code for dialysate solution, non-dextrose containing, 500 ml. It sits in the Transportation, Medical & Surgical Supplies, Administrative section.
Does Medicare cover A4728?
The CMS HCPCS file marks A4728 as "Carrier judgment". Coverage is decided by your Medicare contractor, not by national policy. Whether this is paid depends on the LCD for your jurisdiction and on what the documentation supports.
How is A4728 paid under the physician fee schedule?
A4728 carries PFS status code X. Statutory exclusion. The item or service is not within the statutory definition of 'physician services', so the fee schedule never pays it.