Healthcare Insights
Most fulfilled dialysis equipment and supplies orders
Kidney disease affects one in seven adults in the United States. Currently, there are more than 562,000 people in the United States on dialysis as part of their treatment for kidney disease.
Using the Definitive Healthcare Atlas All-Payor Claims dataset, we identified the top 10 most fulfilled dialysis equipment and supply orders in 2022. This data represents the percentage of fulfilled dialysis equipment and supply orders in the U.S and is based on physician ordering activity. These orders are most likely fulfilled for at-home dialysis procedures.
Because we built this analysis using claims data, the chart only includes orders by physicians that have been billed through insurance. Some patients may opt to buy some supplies or equipment without submitting through insurance. Additionally, some supplies may be covered under a dialysis bundled payment program. Because these orders are primarily for at-home dialysis, supplies are likely ordered in bulk for multiple uses. For example, a single order of a box of sterile gloves may contain enough supply for many dialysis procedures.
| Rank | HCPCS code | HCPCS description | Percent of fulfilled dialysis equipment and supply orders in the U.S. | Explore dataset |
|---|---|---|---|---|
| 1 | A4913 | Misc dialysis supplies noc | 58.60% | Explore |
| 2 | A4670 | Automatic bp monitor, dial | 20.00% | Explore |
| 3 | A4930 | Sterile, gloves per pair | 8.70% | Explore |
| 4 | A4728 | Dialysate solution, non-dex | 5.20% | Explore |
| 5 | A4663 | Dialysis blood pressure cuff | 2.20% | Explore |
| 6 | A4928 | Surgical mask | 1.10% | Explore |
| 7 | A4690 | Dialyzer, each | 0.90% | Explore |
| 8 | A4755 | Comb art/venous blood tubing | 0.70% | Explore |
| 9 | A4709 | Acid conc sol per gallon | 0.40% | Explore |
| 10 | A4770 | Blood collection tube/vacuum | 0.40% | Explore |
Fig. 1. Data is from the Definitive Healthcare Atlas All-Payor Claims dataset for the calendar year 2022. Claims data is sourced from multiple medical claims clearinghouses in the United States and updated monthly. Data accessed in June 2023.
Which medical and surgical equipment orders for dialysis are most fulfilled?
The equipment with the highest percentage of fulfilled orders is miscellaneous dialysis supplies, not otherwise specified (HCPCS code A4913). Dialysis procedures, specifically at-home dialysis, may contain many supplies that do not have specified HCPCS codes, requiring that they are billed under the miscellaneous dialysis supplies category. New or innovative supplies could be captured in this bucket, along with any other supplies that CMS did not designate a specific code for.
Next, the piece of equipment with the second highest percentage of fulfilled orders is an automatic blood pressure monitor (HCPCS code A4670). An automatic blood pressure monitor uses a cuff on the upper arm, wrist, or finger to give a digital reading of blood pressure. Blood pressure is typically monitored before, during, and after dialysis, particularly during hemodialysis, which explains its high ranking. This piece of equipment would be an example of the type of order that would only need to be placed once for each patient, as it can be used multiple times after it has been acquired.
The third most fulfilled dialysis supply order is sterile gloves per pair (HCPCS code A4930). Sterile gloves are used for sterile procedures or procedures where infection is determined to be of concern. As dialysis involves the filtering of blood, it is important for providers or individuals performing the procedure to use sterile gloves to protect patients and themselves from infection. As stated above, orders for supplies like sterile gloves are likely ordered in bulk for providers or patients, which is why the percentage of orders fulfilled is as low as 8.7%. Some patients may also opt to purchase these without submitting through insurance.
What is a HCPCS code?
The Healthcare Common Procedure Coding System (HCPCS) is code set for CMS reporting of medical procedures and services.
HCPCS has two subsystems. The level I subsystem is identical to the American Medical Association’s Current Procedural Terminology (CPT) coding system, which is the coding system for reporting medical services and procedures. The level II subsystem is used to identify products, supplies, and services not covered in the level I subsystem.
HCPCS codes tend to require a higher level of specificity than CPT codes as they contain codes for different variations and amounts of equipment and medicine.
CMS updates the HCPCS code system annually to account for changes in medications, supplies, and equipment.
How does dialysis work?
Dialysis is a kidney failure treatment. It filters blood to remove toxins, waste, and excess fluids.
There are two types of dialysis: peritoneal dialysis and hemodialysis.
Peritoneal dialysis works within the body and allows patients to get dialysis at home. This type of dialysis involves a cleansing fluid administered through tubes in the stomach area and the inner lining of the stomach, which works as a filter to remove waste from the blood.
Hemodialysis uses a dialysis machine to filter the blood. This treatment can be done at a dialysis center, at a hospital, or at home.
Who is on a dialysis care team?
A dialysis care team is typically led by a nephrologist. Nephrologists are physicians trained to treat kidney disease. Nurse practitioners (NPs) or physician assistants (PAs) may also collaborate with nephrologists in caring for patients.
A nephrology nurse often works on the care team, as well. Nephrology nurses, typically registered nurses (RNs) or licensed practical nurses (LPNs), assess patients, administer medications, and oversee dialysis processes.
Patient care technicians (PCTs) are the individuals who perform the dialysis treatment and monitor the patients throughout the procedure.
In addition to these healthcare providers, a patient on dialysis will also work with a renal dietician and nephrology social worker.
Hemodialysis patients also receive care from a vascular access care team. This team typically consists of a vascular access surgeon, a radiologist, and an access coordinator.
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