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PPS Bundled Supply Codes for Medicare HHA Patients

 

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)