HCPCS code A4248 – Chlorhexidine antiseptic, per 1 ml

Key takeaways

A4248 is the HCPCS Level II code for chlorhexidine containing antiseptic, and one unit equals 1 ml.

Alcohol wipes are a different code, A4245, so never bill an alcohol prep pad under A4248.

CMS lists A4248 among the ESRD supplies not payable to DME suppliers, and Part B sets no separate price for it.

For Medicare dialysis patients, the antiseptic is paid inside the facility’s bundled ESRD PPS treatment rate.

Medicaid and commercial plans set their own A4248 rules, so check each payer before you submit a separate line.

HCPCS code A4248: definition and code attributes

HCPCS code A4248 describes chlorhexidine containing antiseptic, 1 ml. It is a Level II supply code that the Centers for Medicare & Medicaid Services (CMS) maintains in its quarterly HCPCS file. Each unit stands for 1 milliliter of a chlorhexidine-based skin antiseptic.

The CMS file classifies the code as an end-stage renal disease (ESRD) supply. That classification decides how, and whether, the code gets paid. The attributes below come straight from the October 2026 CMS HCPCS file and the CY 2026 consolidated billing list.

A4248 is often mistaken for the alcohol wipes code. Alcohol wipes, per box, is A4245, which sits a few codes earlier in the same antiseptic series. The two codes differ in both the product and the unit, so a swap changes the whole claim line.

Clinical context: what A4248 is used for

Dialysis care leans heavily on chlorhexidine. The CDC’s dialysis infection prevention guidance names an alcohol-based chlorhexidine (>0.5%) solution as the first-line skin antiseptic. It applies to central line insertion and to catheter dressing changes.

A4248 covers that antiseptic supply. Typical uses include cleaning the skin around a hemodialysis catheter exit site, prepping before access, and catheter care in home dialysis. Dialysis nurses and technicians apply it, under a plan of care set by the nephrologist.

The descriptor names no concentration or format. Solutions, swabsticks, and applicators can all fall under the code, as long as they contain chlorhexidine. What it does not cover:

• Isopropyl alcohol wipes, which are A4245
• Povidone-iodine swabs or wipes, which are A4247
• Solutions used to clean or sterilize dialysis equipment, which are A4674

The chart below sorts the whole antiseptic family by product and billing unit, so two label checks place any item.

Medicare coverage and reimbursement for HCPCS code A4248

Medicare does not pay A4248 as a separate line. For a dialysis patient, the antiseptic is part of the facility’s bundled per-treatment payment. The ESRD prospective payment system (PPS) covers the drugs, laboratory tests, supplies, and equipment furnished for ESRD treatment.

CMS publishes the affected codes each year in Attachment B of its ESRD PPS consolidated billing list. The CY 2026 list places A4248 in the group headed “DME ESRD supply HCPCS not payable to DME suppliers.” Alcohol wipes (A4245) and iodine swabs (A4247) sit in the same group.

The CMS file backs this up from a second angle. A4248 carries pricing indicator 00, which means Part B sets no separate price for it. There is no DMEPOS fee schedule amount to look up, whatever the care setting.

Older references still talk about the ESRD “composite rate.” The ESRD PPS replaced that rate starting January 1, 2011, and it now bundles far more than the composite rate did. CMS resets the PPS base rate each January in the annual ESRD PPS final rule.

Where the payment sits

The setting and the billing entity decide what happens to an A4248 line. The table shows each route.

A facility still counts milliliters at the chair. That figure does not move a Medicare payment. It does feed cost reports, supply reconciliation, and any payer that prices the code on its own.

How to handle HCPCS code A4248 on a claim

Start with who furnished the antiseptic, because that decides whether a separate line exists at all. Work through these steps before the claim goes out.

1. Identify the billing entity. An ESRD facility reports dialysis on its institutional claim, and the antiseptic is already inside that payment. A DME supplier has no payable Medicare route for A4248.
2. Confirm the product. Check the label for chlorhexidine. An alcohol prep pad belongs under A4245, and an iodine swab under A4247.
3. Count units in milliliters. One unit equals 1 ml. Use the volume printed on the product, not the number of boxes, bottles, or swabsticks.
4. Document the order and the use. Keep the plan of care that calls for catheter or access site antisepsis. A treatment note confirming application supports any review.
5. Read the payer’s policy before adding a separate line. Where a Medicaid or commercial plan prices A4248, its fee schedule sets the rate and any authorization rule.
6. Submit on the right form. Facility treatments go on the institutional claim. A payer that accepts A4248 as a professional supply line takes it on the CMS-1500 form or its 837P equivalent.

Payer coverage beyond Medicare for A4248

Medicare is the primary payer for most patients with ESRD, including many under 65. Medicaid and commercial plans sit alongside it for some patients, and their A4248 policies vary. Billing compliance requirements differ by payer and state, so never treat Medicare’s handling as the default.

• Medicaid: Some state programs follow Medicare and treat dialysis supplies as bundled. Others list A4248 on their own fee schedule. Check your state Medicaid agency’s current list first.
• Commercial payers: Plans may fold the antiseptic into a dialysis case rate or pay it as a separate supply. Read the plan’s supply policy for A-series codes rather than assuming.
• Units on non-Medicare claims: A payer that prices A4248 still expects milliliters, not boxes. Unit errors are the quickest way to a downcoded or rejected line.

HCPCS codes related to A4248

Within the HCPCS Level II code set, A4248 sits in a run of antiseptic and dialysis supply codes. The neighbors describe different products and different units, so verify each descriptor against the current CMS file before billing by code number.

Every code in the table appears on the CY 2026 consolidated billing list, so the Medicare payment question is the same for all of them. Our guides to A4244 and A4246 cover the two per-pint solution codes in detail.

Common billing mistakes with HCPCS code A4248

Most A4248 errors come from treating it like a home diabetes supply or a DMEPOS item. Denial management in healthcare starts with knowing which of these patterns you are prone to.

• Billing alcohol wipes as A4248: An alcohol prep pad is A4245. Using A4248 for it misstates the product on the claim.
• Billing per box or per bottle: The unit is 1 ml. A 30 ml bottle is 30 units on a payer that prices the code, not one.
• Sending a DME supplier claim to Medicare: CMS lists A4248 as not payable to DME suppliers. The line is denied regardless of documentation.
• Defaulting to A4913: The not otherwise specified code is for dialysis supplies with no specific code. A chlorhexidine antiseptic has one.
• Quoting a fee schedule amount: A4248 has no Medicare fee schedule price. A dollar figure from a third-party site does not reflect Medicare payment.

How Pabau keeps dialysis supply records claim-ready

A4248 rarely pays as a separate Medicare line, so the work sits in the record. The plan of care, the treatment note, and the milliliters used need to agree. When they live in separate systems, cost reports and payer claims drift apart.

Pabau, the practice management platform we build, keeps treatment notes, care plans, and consent forms in one patient record. Supply use gets recorded against the visit it belongs to, so the documentation trail is in one place when a payer asks. For faster claims management, Pabau then tracks claim status alongside that record.

Keep supply documentation in one record

Pabau keeps care plans, treatment notes, and supply use in one patient record. Your team can answer payer questions about codes like A4248 without chasing paperwork.

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Conclusion

A4248 is a small code with an outsized chance of being misread. It describes chlorhexidine, not alcohol wipes, and it counts milliliters, not boxes. For Medicare, the dialysis bundle absorbs it, so a separate supplier claim has nowhere to go.

Code the product from its label, record the volume used, and read each non-Medicare payer’s policy before you add a separate line. Doing that keeps the claim accurate and your records ready for review. Book a demo to see how Pabau keeps care plans and treatment notes together for supply billing.

Continue your research

Need to understand how clearinghouse submissions work for supply codes? Medical claims clearinghouse explains the end-to-end electronic claim pathway from submission to remittance.

Want to reduce denial rates across all your billing codes? Clean claim walks through the elements every claim needs to pass payer edits without a rework cycle.

Looking for the denial code definitions behind supply-line rejections? Denial codes in medical billing covers CARC and RARC codes, what they mean, and how to respond to each.

Coding the alcohol prep pads used at the same visit? HCPCS code A4245 explains the per-box alcohol wipes code and how it differs from A4248.

Billing the solution that cleans the dialysis machine? HCPCS code A4674 covers equipment antiseptics billed per 8 oz.

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