HCPCS code A4653 – Peritoneal dialysis catheter anchoring belt

Key takeaways

HCPCS code A4653 describes a peritoneal dialysis catheter anchoring belt, billed per belt, in the A4653 to A4932 dialysis supplies range.

CMS lists A4653 on its ESRD PPS consolidated billing list as a supply that is not payable to DME suppliers.

For Medicare patients with ESRD, the belt is paid inside the bundled rate to the dialysis center, with no separate fee schedule amount.

Urinary catheter anchors use A4333 and A4334, so urological supply policies do not govern A4653.

Pabau keeps the order, the ESRD diagnosis and supply notes on one record, then submits and tracks claims through Claim.MD.

What HCPCS code A4653 covers

HCPCS code A4653 is the Level II code for a peritoneal dialysis catheter anchoring device, belt, each. The belt is worn around the abdomen to secure a peritoneal dialysis (PD) catheter and limit pulling at the exit site.

One unit equals one belt. Because patients on home PD wear it day to day, it usually reaches them through the supply order their dialysis center manages.

Each field in the table comes from the CMS October 2026 HCPCS Level II file. However, CMS can revise descriptors and indicators each quarter, so check the CMS quarterly HCPCS update files before you rely on any field.

Why A4653 is not a urinary catheter code

The word catheter in the descriptor sends some coders to the urological supply rules. However, A4653 anchors a different device. In fact, it secures the catheter that carries dialysate into and out of the peritoneal cavity.

HCPCS gives each catheter type its own anchoring code. Likewise, the pricing indicator shows which payment path each code follows.

The urinary catheter codes sit in a separate range, A4310 to A4360, with their own coverage policies. As a result, quantity limits and diagnosis lists written for those codes do not carry over to a dialysis supply.

How Medicare pays for A4653

Medicare does not pay A4653 as a separate line item for a patient with end stage renal disease (ESRD). Instead, the belt is included in the ESRD prospective payment system (PPS) rate paid to the dialysis center.

Attachment B, the CY 2026 ESRD PPS consolidated billing list, places A4653 under “DME ESRD supply HCPCS not payable to DME suppliers”. In addition, the same list states that all supplies provided for the treatment of ESRD are included in the ESRD PPS.

Likewise, the HCPCS file points the same way. A4653 carries pricing indicator 00, which means Part B sets no separate price for it. Since the ESRD PPS began on January 1, 2011, home dialysis supplies have been part of the center’s bundled payment.

What this means for each billing party

• Dialysis center: The center furnishes the belt as part of home PD support. It is paid through the bundled ESRD PPS rate, and no separate payment follows for the belt.
• DME supplier: Therefore, a DME MAC claim for an ESRD patient’s anchoring belt will not be paid. A supplier that ships belts needs a payment plan with the dialysis center.
• Commercial and Medicaid plans: These payers set their own dialysis rules. Check the plan’s policy before you assume the Medicare bundle applies.

The diagram below follows a claim from catheter type to the party that gets paid.

ICD-10-CM codes that document the need for A4653

The record behind an A4653 supply should show why the patient needs a PD catheter secured. Codes for kidney failure and dialysis status carry that link.

Pick the code the record supports. For example, a belt ordered to prevent displacement does not justify a displacement code by itself. Also, a leaking PD catheter has its own code, T85.631A, separate from displacement and infection. Every descriptor above matches the CMS FY 2026 ICD-10-CM code file.

Related HCPCS codes for peritoneal dialysis supplies

A4653 is one line in a broader family of PD supply codes. Y set tubing for manual exchanges bills under A4719, and disposable catheter tips under A4860. In addition, each code below carries pricing indicator 00 and appears on the same CY 2026 bundled billing list.

Use A4913 only when no specific code fits. A PD catheter belt always has its own code, so it never belongs under the not otherwise specified line.

Where A4653 claims go wrong

A DME supplier claim for an ESRD patient

The most frequent error is a DME MAC claim for a patient whose dialysis center is already paid for the belt. CMS lists the code as not payable to DME suppliers, so that claim line goes unpaid.

Billing the belt under urinary supply rules

Treating A4653 as a urinary catheter accessory pulls in the wrong policy, diagnosis list and units. Urinary catheter anchors belong under A4333 or A4334 instead.

A diagnosis that leaves out dialysis status

N18.6 without Z99.2 leaves the dialysis link unstated. For that reason, record both codes so the supply record matches the patient’s treatment.

Supplies that continue after a modality change

Patients move from PD to hemodialysis, or receive a transplant. In that case, end the belt on the supply order when the PD prescription ends, so shipments stop with the need.

Units that do not match the order

A4653 is counted per belt. Therefore, record how many belts were ordered and delivered, so the supply log reconciles with the center’s records.

Code history and annual updates

CMS added A4653 to HCPCS on January 1, 2003. The latest action on the code took effect on January 1, 2015, and the code remains active in the October 2026 file.

CMS publishes HCPCS Level II updates every quarter, and the ESRD PPS consolidated billing list is reissued for each calendar year. For that reason, recheck both each January before you update order templates. Likewise, the same quarterly cycle applies to every supply code in our HCPCS reference for billers.

How Pabau keeps PD supply records and claims in one place

A month of home PD supplies leaves records in several places. For example, the physician order sits in one file, the ESRD diagnosis in the chart, and delivery notes with whoever shipped the box.

Pabau, the practice management and EHR platform we build, keeps intake forms, consent, treatment notes and diagnoses on one patient record. When a payer asks how a belt was ordered, your team finds the answer in one place.

For claims, Pabau’s claims management software pulls data already on the record into a pre-filled claim. It submits and tracks claims through the Claim.MD clearinghouse, so a stalled claim surfaces early.

However, Pabau does not choose codes or decide whether a payer bundles a supply. Instead, your team still applies the ESRD PPS rules above, with the supporting records ready when they are needed.

Keep dialysis supply records on one patient record

Pabau keeps orders, diagnoses and treatment notes together on one record. Claims you create are submitted and tracked through the Claim.MD integration, so a stalled claim surfaces early.

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Conclusion

A4653 is easy to misread, because the word catheter points coders toward urinary supplies. Read it as a dialysis supply first, and the billing path becomes clear.

For Medicare patients with ESRD, the belt belongs to the center’s bundled rate, never to a DME claim. Finally, confirm dialysis status before any supply claim leaves your system, and recheck the CMS lists each January.

Book a demo to see how Pabau keeps dialysis supply orders, diagnoses and claim status on one patient record.

Continue your research

Billing other peritoneal dialysis supplies? HCPCS code A4719 explains how Y set tubing is paid inside the ESRD bundle.

Need the code for PD catheter tips? HCPCS code A4860 covers disposable catheter tips and their payment status.

Supplying a patient on automated PD? HCPCS code A4671 covers the disposable cycler set and how it is paid.

Seeing supply claims come back denied? Denial codes in medical billing maps common CARC codes to their root causes and fixes.

Want a workflow that catches errors early? What is revenue cycle management explains how to stop errors before they reach the payer.

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