A4212

New Code

Effective 1/1/00

(if applicable)

Non-coring needle or stylet with or without catheter

A4213

Syringe, Sterile 20 cc or greater

A4215

Needles only, sterile any size, each

A4310

Insertion tray without drainage bag and without catheter (accessories only)

A4311

Insertion tray without drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.)

A4312

Insertion tray without drainage bag with indwelling  catheter, foley type, two-way, all silicone

A4313

Insertion tray without drainage bag with indwelling catheter, foley type, three-way, for continuous irrigation

A4314

Insertion tray with drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.)

A4315

Insertion tray with drainage bag with indwelling catheter, foley type, three-way, for continuous irrigation

A4316

Insertion tray with drainage bag with indwelling catheter, foley type, three-way, for continuous irrigation

A4320

Irrigation tray, bulb or piston syringe, any purpose

A4321

Therapeutic agent for urinary catheter irrigation

A4322

Irrigation syringe, bulb or piston, each

A4323

Sterile saline irrigation solution, 1000ml

A4326

Male external catheter specialty type, e.g., inflatable, faceplate, etc., each

A4327

Female external urinary collection device; metal cup, each

A4328

Female external urinary collection device; pouch, each

A4329

External catheter starter set, male/female, includes catheter/urinary collection device, bag/pouch and accessories (tubing, clamps, etc.) 7 day supply, Invalid for DMERC Claims 10/1/95

A4330

Perineal fecal collection pouch with adhesive, each

A4335

Incontinence supply; misc

A4338

Indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.)

A4340

Indwelling catheter, specialty type, (e.g., coude, mushroom, wing, etc.) each

A4344

Indwelling catheter, foley type, two-way, all silicone, each

A4346

Indwelling catheter, foley type, three-way, for continuous irrigation, each

A4347

Male external catheter with or without adhesive, with or without anti-reflux device:  Invalid for DMERC claims 10/1/95

A4351

Intermittent urinary catheter; straight tip

A4352

Intermittent urinary catheter; Coude (curved) tip

A4353

Intermittent urinary catheter with insertion supplies

A4354

Insertion tray with drainage bag but without catheter

A4355

Irrigation tubing set for continuous bladder irrigation through a three-way indwelling foley catheter

A4356

External urethral clamp or compression device (not to be used for catheter clamp)

A4357

Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube

A4358

Urinary leg bag, vinyl, with or without tube

A4359

Urinary suspensory without leg bag

A4361

Ostomy faceplate

A4362

Skin barrier; solid, 4 x 4 or equivalent

A4363

Skin barrier; liquid (spray, brush, etc.) Powder or paste; per oz.

A4364

4369

4370

4371

Adhesive for ostomy or catheter; liquid (spray, brush, etc.) cement, powder or paste; any composition (e.g., silicone, latex, etc.) per oz.

A4365

Ostomy adhesive remover wipes

A4367

Ostomy belt

A4368

Ostomy filter, any type

A4397

Irrigation supply; sleeve

A4398

Ostomy irrigation supply, bag

A4399

Ostomy irrigation supply; cone/catheter including brush

A4400

Ostomy irrigation set,

Invalid for DMERC claims 10/1/93

A4402

Lubricant, per oz.

A4404

Ostomy ring

A4421

Ostomy supply, misc

A4454

Tape, all types and sizes

Invalid for DMERC claims received 9/1/95 or after

A4455

Adhesive remover or solvent (for tape, cement or other adhesive), per oz.

A4460

Elastic bandage per roll (e.g., compression bandage)

A4462

Abdominal dressing holder/binder

A4481

Tracheostoma filter, any type, any size

A4622

Tracheostomy or laryngectomy tube

A4623

Tracheostomy, inner cannula (replacement only)

A4625

Tracheostomy care kit for new trach

A4626

Tracheostomy cleaning brush

A4649

Surgical supplies, misc

-DYNA-FLEX Multi-Layer

Compression System

-BARRIER Sterile Field

A5051

Pouch, closed; with barrier attached (1 piece)

A5052

Pouch, closed; without barrier attached (1 piece)

A5053

Pouch, closed; for use on faceplate

A5054

Pouch, closed; for use on barrier with flange (2 piece)

A5055

Stoma cap

A5061

Pouch, drainable; with barrier attached (1 piece)

A5062

Pouch, drainable; without barrier attached (1 piece)

A5063

Pouch, drainable; for use on barrier with flange (2 piece system)

A5071

Pouch, urinary; with barrier attached (1 piece)

A5072

Pouch, urinary; without barrier attached (1 piece)

A5073

Pouch, urinary; for use on barrier with flange (2 piece)

A5081

Continent device; plug for continent stoma

A5082

Continent device; catheter for continent stoma

A5093

Ostomy accessory; convex insert

A5102

Bedside drainage bottle with or without tubing, rigid or expandable

A5105

Urinary suspensory; with leg bag, with or without tube

A5112

Urinary leg bag; latex

A5113

Leg strap; latex, replacement only

A5114

Leg strap; foam/fabric, replacement only

A5119

Skin barrier wipes

A5121

Skin barrier; solid, 6x6 or equivalent

A5122

Skin barrier; solid, 8x8 or equivalent

A5123

Skin barrier; with flange (solid, flexible or accordion) any size

A5126

Adhesive; disc or foam pad

A5131

Appliance cleaner, incontinence and ostomy appliances, per oz.

A5149

Incontinence/ostomy supply, misc

A6020

Collagen based wound dressing, wound cover

- Fibracol Plus Collagen Wound Drsg with Alginate

A6154

Wound pouch

A6196

Alginate dressing, wound cover, pad size 16 sq in or less

- Tegagen HI Alginate Drsg

- CURASORB Calcium Alginate Drsg

- Sorbsan Wound Dressing

A6197

Alginate dressing, wound cover, pad size > 16 <= sq in 48 sq in

-AlgiDERM Calcium Alginate Dressing

A6198

Alginate dressing, wound cover, pad size > 48 sq in

A6199

Alginate dressing, wound filler, per 6 inches

Same as anything listed in 6196 except in rope form

A6200

Comps drsg <= 16 no border

A6201

Compos drsg > 16 <= 48 no border

A6202

Compos drsg > 48 no border

A6203

Composite drsg, pad size 16 sq inches or less, with any size adhesive border

-Tegaderm Transparent Dressing with absorbent pad

-COVADERM PLUS Adhesive Barrier Dressing

A6204

Composite dressing, pad size > 16 sq inches but less than or equal to 48 sq inches with any size adhesive border

A6205

Composite dressing, pad size > 48 sq inches with any size adhesive border

A6206

Contact layer <= 16 sq inches

A6207

Contact layer > 16 <= 48 sq inches

A6208

Contact layer > 48 sq inches

A6209

Foam dressing, wound cover, pad size <= 16 sq inches without adhesive border

- CURAFOAM Wound Drsg

-MITRAFLEX Absorbent Film Wound Dressing

A6210

Foam dressing, wound cover, pad size > 16 <= 48 sq inches without adhesive border

- SOF-FOAM Dressing

A6211

Foam dressing, wound cover, pad size > 48 sq inches without adhesive border

-Reston Foam Pad

A6212

Foam dressing, wound cover, pad size <= 16 sq inches with any size adhesive border

-TIELLE Hydropolymer Dressing

A6213

Foam dressing, wound cover, pad size > 16 sq inches but <= 48 sq inches with any size adhesive border

A6214

Foam dressing, wound cover, pad size > 48 sq inches with any size adhesive border

A6215

Foam dressing, wound filler, per gram

A6219

Gauze, non-impregnated, pad size <= 16 sq inches with any size adhesive border

- Microdan Soft Cloth Adhesive Wound Dressing

-TELFA Island Dressing

A6220

Gauze, non-impregnated, pad size > 16 <= 48 sq inches with any size adhesive border

-BAND-AID Brand Adhesive Bandage

A6221

Gauze, non-impregnated, pad size > 48 sq inches with any size adhesive border

A6222

Gauze, impregnated, other than water or normal saline, pad size <= 16 sq inches, without adhesive border

-ADAPTIC Non-adhering Drsg

- Vaseline Petrolatum Gauze

-Xerofoam Petrolatum Gauze

A6223

Gauze, impregnated, other than water or normal saline, pad size > 16 <= 48 sq inches without adhesive border

-CURASALT Sodium Chloride Dressing

A6224

Gauze, impregnated, other than water or normal saline, pad size > 48 sq inches without adhesive border

A6228

Gauze, impregnated, water or normal saline, pad size <= 16 sq inches without adhesive border

A6229

Gauze, impregnated, water or normal saline, pad size > 16 <= 48 sq inches without adhesive border

A6230

Gauze, impregnated, water or normal saline, pad size > 48 sq inches without adhesive border

A6234

Hydrocolloid dressing, wound cover, pad size <= 16 sq inches without adhesive border

-Tegasorb Hydrocolloid Drsg

-Sorbex Hydrocolloid Drsg

-Ultec Hydrocolloid Drsg

DuoDERM CGF Control Gel Formula Dressing

A6235

Hydrocolloid dressing, wound cover, pad size > 16 <= 48 sq inches without adhesive border

A6236

Hydrocolloid dressing, wound cover, pad size > 48 sq inches without adhesive border

A6237

Hydrocolloid dressing, wound cover, pad size <= 16 sq inches with any size border

A6238

Hydrocolloid dressing, wound cover, pad size > 16 <= 48 sq inches with any size adhesive border

A6239

Hydrocolloid dressing, wound cover, pad size > 48 sq inches with any size adhesive border, per fluid oz.

A6240

Hydrocolloid dressing, wound filler paste, per fluid oz.

A6241

Hydrocolloid dressing, wound filler dry form, per gram

A6242

Hydrogel dressing, wound cover, pad size <= 16 sq inches without adhesive border

-Tegagel Hydrogel Wound      Filler with gauze

  -NU-GEL Wound Dressing

 -Vigilon Primary Wound Drsg

 -CURAGEL Hydrogel Drsg

A6243

Hydrogel dressing, wound cover, pad size > 16 <= 48 sq inches without adhesive border

A6244

Hydrogel dressing, wound cover, pad size > 48 sq inches without adhesive border

A6245

Hydrogel dressing, wound cover, pad size <= 16 sq inches with any size adhesive border

A6246

Hydrogel dressing, wound cover, pad size > 16 <= 48 sq inches with any size adhesive border

-CURAGEL Hydrogel Island

Drsg

A6247

Hydrogel dressing, wound cover, pad size > 48 sq inches with any size adhesive border

A6251

Specialty absorptive dressing, wound cover, pad size <= 16 sq inches without adhesive border

A6252

Specialty absorptive dressing, wound cover, pad size > 16 <= 48 sq inches without adhesive border

-SURGIPAD Combine Drsg

-TENDERSORB

WET-PRUF ABD Pad

A6253

Specialty absorptive dressing, wound cover, pad size > 48 sq inches without adhesive border

A6254

Specialty absorptive dressing, wound cover, pad size <= 16 sq inches with any size adhesive border

-TELFA XTRA Barrier

Island Dressing

A6255

Specialty absorptive dressing, wound cover, pad size > 16 <= 48 sq inches with any size adhesive border

A6256

Specialty absorptive dressing, wound cover, pad size > 48 sq inches with any size adhesive border

A6257

Transparent film <= 16 sq inches

-Tegaderm Transparent Drsg

-Tegaderm HP Transparent Drsg

-BIOCLUSIVE Transparent Drsg

A6258

Transparent film > 16 <= 48 sq inches

A6259

Transparent film > 48 sq inches

A6261

Wound filler gel/paste not elsewhere classified, per fluid oz.

-MULTIDEX Gel

A6262

Wound filler dry form not elsewhere classified, per gram

-Absorption Dressings, dry flakes

-MULTIDEX Hydrophilic Powder Wound Dressing

A6266

Gauze impregnated, other than water or normal saline, any width, per linear yard

A6402

Gauze, non impregnated, sterile, pad size <= 16 sq inches without adhesive border

-MIRASORB Sponge

-NU GAUZE General Use Sponge

-SOF-WICK Drsg Sponge

-TOPPER Drsg Sponge

-STERI-PAD Gauze Pad

-KERLIX Sponge

-TELFA “Ouchless” Non-adherent Dressing

A6403

Gauze, non impregnated, sterile, pad size > 16 <= 48 sq inches without adhesive border

-KLING Fluff Sponge

-KERLIX Super Sponge

A6404

Gauze, non impregnated, sterile, pad size > 48 sq inches without adhesive border

A6405

Gauze, elastic, sterile, all types, per linear yard

A6406

Gauze, non-elastic, sterile, all types, per linear yard

-SOF-KLING Conforming Bandage

-KLING Conforming Gauze Bandage

-KLING Fluff Roll

-NU GAUZE Packing Strip

-KERLIX Roll

K0277

A4372

Skin barrier; solid 4x4 or equivalent, standard wear, with built-in convexity

K0278

A4373

Skin barrier; with flange (solid, flexible or accordion), standard wear, with built-in convexity, any size

K0279

A4374

Skin barrier; with flange (solid, flexible or accordion), extended wear with built-in convexity, any size

K0280

Extension drainage tubing, any type, any length, with connector/adaptor, for use with urinary leg bag or urostomy pouch

K0281

Lubricant, individual sterile packet, for insertion of urinary catheter

K0407

Urinary catheter, anchoring device, adhesive skin attachment

K0408

Urinary catheter, anchoring device, leg strap

K0409

Sterile H2O irrigation solution

K0410

Male external catheter with adhesive coating

K0411

Male external catheter with adhesive strip

K0419

A4375

Pouch, drainable, with faceplate attached, plastic

K0420

A4376

Pouch, drainable, with faceplate attached, rubber

K0421

A4377

Pouch, drainable, for use on faceplate, plastic

K0422

A4378

Pouch, drainable, for use on faceplate, rubber

K0423

A4379

Pouch, urinary, with faceplate attached, plastic

K0424

A4380

Pouch, urinary, with faceplate attached, rubber

K0425

A4381

Pouch, urinary, for use on faceplate, plastic

K0426

A4382

Pouch, urinary, for use on faceplate, heavy plastic

K0427

A4383

Pouch, urinary, for use on faceplate, rubber

K0428

A4384

A4385

Ostomy faceplate equivalent, silicone ring

K0429

A4386

Skin barrier, solid 4x4 or equivalent, extended wear without built-in convexity

K0430

A4387

Skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, any size

K0431

A4388

Pouch, closed, with standard wear barrier attached, with built-in convexity (1 piece)

K0432

A4389

Pouch, drainable, with extended wear barrier attached, without built-in convexity (1 piece)

K0433

A4390

Pouch, drainable, with standard wear barrier attached, with built-in convexity (1 piece)

K0434

A4391

Pouch, drainable, with extended wear barrier attached, with built-in convexity (1 piece)

K0435

A4392

Pouch, urinary, with extended wear barrier attached, without built-in convexity (1 piece)

K0436

A4393

Pouch, urinary, with standard wear barrier attached, with built-in convexity (1 piece)

K0437

A4394

Pouch, urinary, with extended wear barrier attached, with built-in convexity (1 piece)

K0438

A4395

Ostomy deodorant for use in ostomy pouch, liquid, per oz.

K0439

A4396

Ostomy deodorant for use in ostomy pouch, solid, per tablet