## **What is HCPCS code A4927?**
HCPCS Code A4927, a level II code, has a service type of "Medical and Surgical Supplies". This code falls under the category of dialysis equipment and supplies, frequently used within dialysis clinics or other outpatient settings, and represents a batch of non-sterile gloves, billed per 100 units.
These gloves are typically used in settings where sterility is not required—such as general patient interaction, non-invasive procedures, or handling supplies under standard precautions. Typically, it is used in home care, such as for administering medications, wound care, or performing dialysis.
This code is used by suppliers, pharmacies, and other providers to bill for a box of 100 non-sterile gloves provided to a patient.
Note that this code has a pricing indicator code of 00, which means that the service is not separately priced by Part B (e.g., services not covered, bundled, used by Part A only, etc.). It also has a multiple pricing indicator code of 9, which means it is not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99').
## **HCPCS code A4927 documentation requirements**
Coverage and payment for supplies like A4927 are subject to the specific rules of the payer (e.g., Medicare, Medicaid, or private insurance). Note that for Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS), the documentation must clearly demonstrate medical necessity.
Essential documentation requirements generally include:
- **Standard Written Order (SWO)**: A valid, detailed order from the treating practitioner (physician, PA, NP, etc.) must be obtained and retained by the supplier before a claim is submitted. The order should specify the item (A4927), the quantity, and the frequency (e.g., 1 box per month).
- **Medical record documentation**: The patient's medical record must contain documentation that supports the medical necessity for the non-sterile gloves. This includes a covered medical condition or diagnosis that necessitates the use of non-sterile gloves (e.g., home peritoneal dialysis, specific wound care needs, or other infection control requirements).
- **Justification for quantity**: If the requested quantity exceeds the payer's usual maximum limit (e.g., more than one box of 100 per month, as set by some state Medicaid programs), the medical record must contain a clear explanation and supporting documentation for the increased need.
- **Proof of Delivery (POD**): The supplier must maintain documentation (e.g., delivery ticket, log) showing the date the supplies were delivered to the beneficiary and the quantity delivered.
## **A4927 billing requirements**
Key guidelines for billing HCPCS A4927 are:
- **Payer-specific policy**: Coverage is dependent on the payer's specific Local Coverage Determination (LCD) or coverage policy for medical and surgical supplies or dialysis-related supplies.
- **Unit of service**: Bill the code using the unit of measure of "per 100," meaning one unit equals one box of 100 non-sterile gloves.
- **Quantity limits**: Many payers, particularly state Medicaid programs, enforce monthly quantity limits. For example, one state's policy may limit A4927 to 4 boxes (4 units) per month. Quantities exceeding this limit often require Prior Authorization (PA) and robust documentation of medical necessity.
- **Bundling/inclusion**: For patients receiving home dialysis, many supplies are bundled into the composite rate paid for dialysis services, so billing for A4927 separately may not be permitted if the patient is under a comprehensive dialysis payment system.
## **Other relevant codes**
- **A4930**: Gloves, sterile, per pair
- **A4928**: Surgical mask, per 20
- **A4918**: Venous pressure clamp, for hemodialysis, each
- **A4913**: Miscellaneous dialysis supplies, not otherwise classified
- **A4206 - A4932**: Range of codes for Medical and Surgical Supplies, often including Dialysis Equipment and Supplies.
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