HCPCS A4216: Sterile Water, Saline, And/Or Dextrose Flush, 10 ml

No. Reimbursement depends on medical necessity and payer policies. If the item is considered integral to or bundled with a primary procedure, or if the quantity exceeds utilization guidelines without proper justification, separate payment may be denied. For Medicare, coverage is subject to National and Local Coverage Determinations.

No. While commonly used as an IV flush or diluent for infusions/injections, A4216 can also be covered as a supply item for other medically necessary services, such as nebulizer treatments (as a diluent or part of a nebulization mix) and suctioning (as sterile water/saline for cleaning or flushing a tracheostomy or other tube, when covered).

Utilization guidelines vary by payer hence it is best to contact the payer to clarify. For certain uses, such as with nebulizers, Medicare Local Coverage Determinations (LCDs) often specify a monthly limit, such as 56 units/month for sterile saline or water (10mL/unit), or require documentation to justify a higher quantity. Check the relevant LCD for the item's specific use.