HCPCS code A4802 – Protamine sulfate for hemodialysis

Key takeaways

A4802 is the HCPCS Level II code for protamine sulfate, for hemodialysis, per 50 mg. Protamine reverses the anticoagulant effect of heparin.

Medicare does not pay A4802 separately. CMS gives it pricing indicator 00 and lists it on the CY2026 ESRD PPS consolidated billing list.

The dialysis facility’s per-treatment ESRD PPS payment covers the drug. A separate claim line for it denies as bundled.

CMS lists A4802 among ESRD supplies not payable to DME suppliers, so a supplier cannot bill it to a DME MAC.

Pabau, the practice management platform we build, keeps the ESRD diagnosis, the codes your team chose and each claim’s status on one patient record.

HCPCS code A4802: Definition and official descriptor

HCPCS code A4802 is defined by the Centers for Medicare and Medicaid Services (CMS) as protamine sulfate, for hemodialysis, per 50 mg. It belongs to HCPCS Level II, the CMS set of HCPCS codes for drugs, supplies and services that CPT codes do not describe.

Protamine sulfate binds heparin and neutralizes its anticoagulant effect. Dialysis units use heparin to stop blood clotting in the extracorporeal circuit. Protamine is the agent that reverses that heparin when the care team needs to.

Although A4802 names a drug, CMS files it with the A-series dialysis supplies. Its type of service code is L, which CMS uses for ESRD supplies. That placement explains how Medicare treats it on a claim.

Under Medicare, A4802 is not separately payable. It is included in the ESRD Prospective Payment System (PPS) bundle, which pays the dialysis facility one rate per treatment.

A4802 code details at a glance

Every value in this table comes from the October 2026 CMS Alpha-Numeric HCPCS file and the CY2026 ESRD PPS consolidated billing list.

What A4802 covers and what it excludes

A4802 covers protamine sulfate given in connection with hemodialysis, reported in 50 mg units. It describes the drug only. The dialysis treatment and the other supplies used in it are reported separately by the facility.

Three nearby situations call for a different code, or no code of their own:

• Protamine outside dialysis: J2720 describes injection, protamine sulfate, per 10 mg. It is the general drug code, priced in 10 mg units rather than 50 mg units.
• The heparin being reversed: Heparin has its own codes, such as J1644 for injection, heparin sodium, per 1000 units. CMS lists J1644 on the same consolidated billing list.
• A dialysis supply with no named code: A4913 covers miscellaneous dialysis supplies, not otherwise specified. It is never a substitute for A4802 when protamine was given.

No A4800, A4801 or A4803 code exists in the current CMS HCPCS file. Treat any reference to them as an error, and pick a code only from the CMS file itself.

The decision path below shows which protamine code fits and who is paid for the drug.

How ESRD PPS consolidated billing applies to A4802

The ESRD PPS is the billing framework for A4802. CMS bundles dialysis-related drugs, labs, supplies and services into a single per-treatment payment to the ESRD facility. Protamine given for dialysis is part of that bundle.

The CY2026 ESRD PPS consolidated billing list names A4802 twice. It appears among ESRD supplies not payable to DME suppliers. It appears again among the composite rate drugs and biologicals.

CMS notes that the list is not all-inclusive. Injectable drugs, labs, supplies and services furnished for the treatment of ESRD are included in the ESRD PPS, whether or not the list names them.

In-center (facility) dialysis

When dialysis takes place at a Medicare-certified ESRD facility, the per-treatment payment covers the protamine used. The facility reports the dialysis on its institutional claim. A separate claim line asking for payment for A4802 is denied as bundled.

Home dialysis

Home dialysis drugs and supplies are bundled too. Method II, which let a supplier bill a DME MAC directly for home dialysis supplies, ended on January 1, 2011. Since then, the ESRD facility furnishes or arranges home items and receives the bundled payment.

Who can bill A4802: Dialysis facility vs DME supplier

Billing rights for A4802 turn on who furnished the drug. That answer decides whether anyone may bill Medicare for it at all.

A supplier that ships protamine for a home patient should invoice the ESRD facility, not the DME MAC. Resubmitting the same line to Medicare only repeats the denial.

A4802 reimbursement: Why there is no fee schedule rate

A4802 has no Medicare fee schedule rate of its own. Pricing indicator 00 means Part B does not price it separately. There is no locality-adjusted amount and no per-milligram payment to look up.

The drug is paid through the ESRD facility’s per-treatment PPS payment. That payment does not change with the number of 50 mg units a patient receives.

CMS updates the consolidated billing list each year. Check the current version on the CMS ESRD PPS consolidated billing page before you set billing rules for dialysis drugs.

Related HCPCS codes

These codes sit close to A4802 in practice. Each descriptor below is copied from the October 2026 CMS Alpha-Numeric HCPCS file.

Our guides to A4913 and A4750 show how two other bundled dialysis supply codes are documented.

How to document protamine use for a dialysis patient

Correct use of HCPCS code A4802 starts in the chart, before anyone picks the code. Practices that use claims management software can turn these checks into a pre-submission routine.

1. Confirm the ESRD diagnosis: The patient record must include an active ESRD diagnosis. The facility claim carries ICD-10-CM N18.6 (end-stage renal disease).
2. Record the dose: Chart the protamine dose in milligrams and the time it was given. Convert it to 50 mg units for any line that reports A4802.
3. Record the reason: Note why reversal was needed, such as prolonged bleeding from the access site. The note supports the treatment record and later audits.
4. Confirm who bills: The ESRD facility reports the dialysis on its institutional claim and receives the bundled payment. A DME supplier does not bill Medicare for the drug.
5. Keep supply records: File the invoice or dispensing record for the protamine. It supports cost reporting even though it earns no separate payment.

A clean claim for a dialysis patient needs the diagnosis and the billing route settled before it is filed. The other steps protect the facility when an auditor asks how the drug was handled.

Medicaid and commercial payer considerations

The bundling rule above governs traditional Medicare claims. Medicare Advantage plans, state Medicaid programs and commercial payers set their own payment policies for dialysis drugs.

Many follow Medicare’s bundled approach. Others pay dialysis under a negotiated facility rate. Check the payer’s dialysis policy or contract before you report A4802 as a separate line.

Common reasons A4802 claims are denied

Most A4802 denials trace back to one misunderstanding, which is treating the code as separately payable under Medicare. Effective denial management in healthcare starts with catching that error before the claim is filed.

How Pabau keeps dialysis billing records in one place

Dialysis billing teams often track diagnoses, drug doses and claim outcomes in separate places. That makes it easy to send a bundled drug out as its own claim line, then lose time on the denial.

Pabau keeps that work on one patient record. The diagnosis, the codes your team entered on each claim and the claim’s status sit side by side.

With one record per patient, your team can see the ESRD diagnosis and the codes on a claim before it is filed. Denials that do arrive are easier to trace back to their cause.

Keep dialysis codes and claims in one place

Pabau puts the ESRD diagnosis, the codes your team chose and each claim’s status on one patient record. Your billing team can review each dialysis claim from one place.

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Conclusion

Under Medicare, A4802 records protamine given for hemodialysis and earns no payment of its own. The drug is paid inside the ESRD facility’s per-treatment rate, in-center or at home.

Your work is to chart the dose and the reason, link the ESRD diagnosis and route the drug through the facility. Do that, and the claim is clean and audit-ready. A separate A4802 claim only creates a denial to work.

Book a demo to see how Pabau keeps the diagnosis, the codes your team entered and each claim’s status on one patient record.

Continue your research

Billing a dialysis supply with no named code? HCPCS code A4913 explains how the miscellaneous dialysis supply code sits inside the ESRD PPS bundle.

Struggling with claim rejections across your coding team? Denial codes in medical billing explains the most common CARC and RARC codes and how to resolve each one.

Want to understand the full claims lifecycle? What is medical billing explains how codes move from service delivery to payment posting.

Unsure what makes a claim clean? Clean claim requirements outlines the elements payers check before processing a claim.

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