HCPCS code H0022: Alcohol and drug intervention billing guide
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Last Updated: July 30, 2026
Key takeaways
HCPCS code A4706 describes bicarbonate concentrate solution for hemodialysis, billed per gallon as the unit of service, not per 10 mEq.
A4706 sits on CMS’s ESRD PPS consolidated billing list. It is typically bundled into the dialysis facility’s per-treatment payment rather than billed separately to a DME MAC.
Related codes A4707, A4708, and A4709 also describe hemodialysis concentrates, while A4714 is the peritoneal dialysis code in the cluster. Mixing up the modality is the most common coding error here.
Practice management software like Pabau validates the claim fields insurers require before submission. That helps billing teams keep bundled ESRD supply codes off claims that should carry only separately payable items.
HCPCS code A4706 covers bicarbonate concentrate solution for hemodialysis, billed per gallon. It sits right next to a run of similarly worded peritoneal dialysis codes that billers often confuse it with. That mix-up matters less than a second detail. A4706 appears on CMS’s ESRD PPS consolidated billing list, so the dialysis facility bills for it, not an independent DME supplier.
Get that distinction right, and the rest follows. Confirm which of A4706, A4707, A4708, or A4709 matches the product on hand. Then check how it differs from A4714, the peritoneal dialysis code next to it.
The details below follow CMS’s HCPCS Level II framework. It’s built for dialysis facility billers, coders, and practice managers who need the distinction to hold up at audit time.
What HCPCS code A4706 covers
HCPCS code A4706 is a Level II HCPCS supply code maintained by the Centers for Medicare and Medicaid Services (CMS). It describes a specific concentrate solution used in hemodialysis treatment. Its precise unit of measure affects how the supply is tracked and, where applicable, billed.
Level II HCPCS codes cover items and services not described by CPT codes, including DMEPOS supplies like B4180, ambulance services, and certain drugs.
A4706 sits within the A4 supply group, which runs from A4206 through A4927 and covers everything from A4320 to dialysis concentrates. Within that group, A4706 specifically covers hemodialysis concentrate supply for ESRD dialysis facilities.
Bicarbonate concentrate solution: clinical role in hemodialysis
Understanding what this supply actually does helps coders apply A4706 accurately. It also helps them avoid miscoding it against the peritoneal dialysis codes that sit nearby in the A4 series.
Bicarbonate concentrate solution is one half of the two-part concentrate a hemodialysis machine mixes with treated water to form dialysate. Dialysate is the fluid that draws waste products and excess fluid out of the blood across the dialyzer membrane. The machine’s proportioning system combines it with an acid concentrate, billed separately under A4709, in a fixed ratio during treatment.
Bicarbonate-based dialysate is the standard buffer in modern hemodialysis, since it causes fewer intradialytic complications, such as low blood pressure, than the older acetate-based formula.
Both in-center hemodialysis and most home hemodialysis programs use bicarbonate concentrate as a standard supply component. It’s mixed fresh at the time of each treatment rather than pre-mixed and stored.
The “per gallon” unit is not interchangeable with the mEq-based units used on other dialysis concentrate codes. Facilities that track concentrate usage for internal supply and cost-accounting purposes total the gallons used per period directly, with no conversion required.
Good patient documentation practices around the dialysis prescription support accurate supply tracking, even when the code itself isn’t billed as a separate claim line.
Pro Tip
Confirm the concentrate delivery record reports gallons, not milliequivalents or bottle count, before pulling A4706 into a supply report. A4706 sits on CMS’s ESRD PPS consolidated billing list, so most dialysis facilities won’t submit it as a stand-alone Medicare claim line at all. Treat the gallon total as an internal supply-tracking figure, and confirm with the specific payer before assuming otherwise.
How Medicare covers and reimburses A4706
Medicare Part B covers bicarbonate concentrate for eligible ESRD hemodialysis patients, but not as a standalone DMEPOS claim. Coverage runs through the ESRD Prospective Payment System (PPS), the single bundled payment CMS makes to the dialysis facility for each treatment.
Bicarbonate concentrate is bundled, so a dialysis facility doesn’t submit a separate Part B claim line for A4706. A DME supplier would submit one for an unrelated home medical supply, but not for this bundled code.
CMS’s Attachment B to the ESRD PPS consolidated billing list names A4706 among the DME ESRD supply codes not payable to DME suppliers. The same list includes A4707, A4708, A4709, A4714, and A4690.
CMS’s guidance addresses this directly. If another provider or supplier furnishes a consolidated-billing item like bicarbonate concentrate to a Medicare ESRD beneficiary, it looks to the ESRD facility for payment. It does not bill its own Medicare Administrative Contractor directly.
Facilities and suppliers should always confirm current policy against the CMS ESRD PPS consolidated billing overview, since the specific item list is refreshed annually. Tracking these annual updates is one area where organized compliance documentation pays dividends at audit time.
How to bill A4706 correctly
Accurate A4706 billing starts with recognizing who actually submits the code.
ESRD PPS consolidated billing takes it out of standard DMEPOS practice for most Medicare patients. The following guidelines reflect current CMS consolidated billing policy; always confirm against your facility’s Medicare Administrative Contractor instructions.
Who may bill A4706
Under ESRD PPS consolidated billing, the certified dialysis facility furnishes bicarbonate concentrate to its Medicare ESRD patients.
The cost is built into the facility’s bundled per-treatment payment rather than billed as a separate claim line. An independent DMEPOS supplier generally can’t bill A4706 separately to a DME MAC for a patient receiving Medicare-covered dialysis at a certified ESRD facility. CMS’s consolidated billing edits reject those claims.
Documentation you need to support A4706
- The physician’s written orders or comprehensive plan of care specifying the dialysate and concentrate formulation used in the patient’s hemodialysis prescription
- Internal supply and inventory records showing the gallons of bicarbonate concentrate used, kept for cost accounting and facility audit purposes rather than per-claim submission
- Documentation confirming the patient’s ESRD diagnosis and enrollment in the facility’s Medicare-approved dialysis program
- Records showing which concentrate formulation, bicarbonate or acetate, is prescribed, since a formulation change is a clinical decision that belongs in the care plan
- Evidence that the facility holds current ESRD certification under its Medicare provider agreement
How to calculate and report the unit
The unit of service for A4706 is per gallon, not per 10 mEq and not per bottle. A facility tracking concentrate usage for internal supply and cost-accounting purposes totals the gallons of solution used during a period. It records that figure directly, with no conversion needed.
For example, a facility that uses 45 gallons of bicarbonate concentrate solution in a month records 45 gallons, with no conversion step. The unit already matches how the product is purchased and stored.
Robust EHR and billing system integration helps a facility pull concentrate usage directly from inventory records instead of re-entering figures by hand. This matters most for facilities running multiple dialysis stations, where manual tracking is the easiest place for a modality mix-up to slip through.
Why standard DME modifiers don’t apply here
Because A4706 is a consumable dialysis supply bundled into the ESRD PPS payment, standard DME equipment modifiers don’t apply to it. Don’t append the NU (new equipment) or RR (rental) modifier, since both describe durable equipment transactions rather than a bundled concentrate supply.
The dialysis facility bills for the treatment, including the bundled concentrate cost, on the institutional claim form (UB-04, or its 837I electronic equivalent). That’s different from the CMS-1500 form a DME supplier would use.
Confirm current modifier and billing requirements against your facility’s Medicare Administrative Contractor rather than defaulting to standard DMEPOS modifier logic.
How A4706 fits into ESRD PPS supply billing
A4706 sits within CMS’s ESRD PPS consolidated billing framework, which changes how it’s billed compared with a typical DMEPOS supply code.
Understanding where it fits helps billers avoid two common mistakes. The first is treating it like a standalone DME claim. The second is confusing it with the peritoneal dialysis codes that sit right next to it in the A4 series.
The dialysis supply cluster within the A4 series splits cleanly by modality. Hemodialysis codes like A4706, A4707, A4708, A4709, and A4690 describe concentrates and dialyzers used with a hemodialysis machine. A4714, by contrast, describes treated water used for peritoneal dialysis exchanges.
Vascular access services, like placing a tunneled dialysis catheter, sit outside this same bundle. They’re physician procedures billed separately from the facility’s routine supply costs.
A4714, the peritoneal dialysis code in this cluster, is bundled the same way A4706 is. CMS’s ESRD PPS consolidated billing list places A4714 alongside A4690, A4706, A4707, A4708, and A4709 as not payable to DME suppliers.
The real difference between A4706 and A4714 is modality and product, not the billing mechanism. A4706 covers hemodialysis concentrate, and A4714 covers treated water for peritoneal dialysis exchanges.
Practices managing complex supply and cost-tracking workflows across multiple codes benefit from practice management software features built to keep the codes distinct by modality. A general-purpose system, by contrast, tends to treat every supply code the same way.
The Pricing, Data Analysis and Coding (PDAC) contractor at CMS provides coding verifications for DMEPOS products, confirming which HCPCS code applies to specific product types.
A concentrate product can sometimes plausibly map to more than one A4-series code. Requesting a PDAC coding verification before assuming a modality can prevent downstream confusion. This verification process is documented in detail through CGS Medicare’s coding verification guidance.
The HCPCS codes billers confuse with A4706
A4706 does not exist in isolation. Dialysis facility billers typically work with a cluster of related A4-series codes that split cleanly between hemodialysis and peritoneal dialysis. The table below presents the most commonly confused adjacent codes.
The key distinction to remember is this: A4706 is the solution form of bicarbonate concentrate for hemodialysis. The dialysis machine mixes it with acid concentrate, A4709, and treated water to form dialysate. A4707 is the powder form of the same hemodialysis buffer.
A4714 is the only peritoneal-dialysis-specific code in this cluster, and it covers treated water rather than a concentrate. Confusing the modality is the most common error, since the descriptors read similarly. Use the AAPC Codify HCPCS lookup to verify code descriptions before relying on a supply record.
Practices that maintain systematic patient data and supply records have an easier time matching dispensed items to the correct code.
Pro Tip
Review A4706, A4707, A4708, and A4709 together when auditing hemodialysis supply records, since CMS groups all four on the same ESRD PPS consolidated billing list. Don’t confuse any of them with A4714, the one peritoneal-dialysis-specific code in the cluster. Because all five sit under consolidated billing rather than standard DME billing, a quarterly internal audit catches modality mix-ups before they affect cost reporting.
Is A4706 still valid for 2025 and 2026?
Yes, A4706 is active for both years on the most recent CMS files reviewed. HCPCS Level II codes are updated annually by CMS, typically with an effective date of January 1.
Codes can be added, revised, or deleted in any given cycle. CMS also republishes the ESRD PPS consolidated billing attachment each year, which is the more relevant document for a bundled code like A4706.
The annual CMS HCPCS update file is the authoritative source for code validity. Billers should download the current year’s file from CMS’s HCPCS overview page at the start of each calendar year.
A4706 is bundled under ESRD PPS consolidated billing rather than priced on a separate fee schedule. The more useful annual check is the ESRD PPS consolidated billing page referenced above. It confirms whether A4706 is still classified as not payable to DME suppliers.
Keeping code validity current is part of a broader billing compliance workflow. Dialysis facilities should monitor both the annual HCPCS update file and the ESRD PPS consolidated billing attachment. A code’s payable or bundled status can shift from one year to the next.
Practices that automate this review through their practice management system avoid the risk of treating a bundled code as if it were still separately billable.
How Pabau supports HCPCS billing workflows
Managing Level II HCPCS supply codes like A4706 takes more than a code lookup tool. That’s especially true once a code moves onto CMS’s ESRD PPS consolidated billing list and stops behaving like a standard DMEPOS claim line.
Billing teams need a workflow that keeps bundled codes off claims that should only carry separately payable items. Physical therapy practices and chiropractic practices face the same bundled, per-visit billing challenge, just with a different set of codes.
Practice management software like Pabau’s claims management software validates the fields insurers require before a claim goes out. It also blocks submission when something’s missing or invalid. That combination helps catch a bundled supply code before it reaches a payer that will reject it.
The patient record system stores the facility’s dialysis prescription and supply documentation alongside clinical records. That makes it easy to retrieve if a Medicare Administrative Contractor ever asks for it.
For dialysis facilities and DMEPOS suppliers handling multiple HCPCS supply codes across a patient population, Pabau’s reporting tools show claim status across the code cluster. That supports audit readiness without a separate coding reference for every code family.
Keeping supply code documentation organized is one of the fundamentals of effective practice management in dialysis and DMEPOS settings.
Keep bundled and billable HCPCS codes straight before you submit
Pabau's claims management software validates the fields insurers require before a claim goes out and blocks submission if something's missing. That way, a bundled ESRD supply code doesn't slip onto a claim line by mistake.
Conclusion
Two checks cover most of the billing risk with A4706. First, confirm which of A4706, A4707, A4708, or A4709 actually matches the product on hand, since the descriptors read alike. Second, check the current ESRD PPS consolidated billing list before assuming a separate claim line applies. That list decides who bills, not the HCPCS code alone.
Pabau’s claims management tools help dialysis facilities keep bundled supply codes off claims that should carry only separately payable items. That reduces the denial and overpayment risk that comes from misclassifying a consolidated-billing code. To see how Pabau handles HCPCS supply code workflows, book a demo with the team.
Continue your research
Vaccinating dialysis patients against Hepatitis B? G0010 covers the administration billing that often accompanies routine ESRD infection-control protocols.
Placing a tunneled dialysis catheter for vascular access? C1894 covers the introducer sheath billed separately from the ESRD PPS bundle.
Struggling to keep recurring dialysis appointments on schedule? Scheduling patients effectively covers strategies for keeping a high-frequency treatment calendar full and on time.
Frequently asked questions
What happens if a DME supplier bills A4706 to the wrong payer?
CMS’s consolidated billing edits catch this automatically and reject the claim. The supplier has to rebill the dialysis facility for the cost instead of appealing. A DME MAC was never the right payer for this code.
Do CPT codes for the dialysis session itself apply alongside A4706?
Yes. Facilities report the hemodialysis session under CPT codes like 90935 or 90937. A4706 does not get its own claim line, since it rides inside that same ESRD PPS bundled payment.
Does Medicaid cover A4706 the same way Medicare does?
Most state Medicaid programs follow Medicare’s ESRD PPS bundling model for hemodialysis supplies. Coverage details still vary by state, so confirm the current state plan’s consolidated billing policy before assuming it matches Medicare exactly.
Who arranges bicarbonate concentrate for a home hemodialysis patient?
The certified dialysis facility still handles it, even for home treatment. The facility purchases and delivers the concentrate, then bills it under the ESRD PPS bundle. The patient never buys it directly from a supplier.
Does Medicare Advantage bill A4706 the same way as original Medicare?
Medicare Advantage plans must cover ESRD dialysis benefits at least as generously as original Medicare. Some plans negotiate different bundled payment terms with facilities, so check the specific plan’s provider contract rather than assuming the standard PPS rate applies.
