| A4331 |
EXTENSION DRAINAGE TUBING, ANY TYPE, ANY LENGTH, WITH CONNECTOR/ADAPTOR, FOR
USE WITH URINARY LEG BAG OR UROSTOMY POUCH, EACH |
| A4357 |
BEDSIDE DRAINAGE BAG, DAY OR NIGHT, WITH OR WITHOUT ANTI-REFLUX DEVICE, WITH
OR WITHOUT TUBE, EACH |
| A4361 |
OSTOMY FACEPLATE, EACH |
| A4362 |
SKIN BARRIER; SOLID, 4 X 4 OR EQUIVALENT; EACH |
| A4363 |
OSTOMY CLAMP, ANY TYPE, REPLACEMENT ONLY, EACH |
| A4364 |
ADHESIVE, LIQUID OR EQUAL, ANY TYPE, PER OZ |
| A4366 |
OSTOMY VENT, ANY TYPE, EACH |
| A4367 |
OSTOMY BELT, EACH |
| A4368 |
OSTOMY FILTER, ANY TYPE, EACH |
| A4369 |
OSTOMY SKIN BARRIER, LIQUID (SPRAY, BRUSH, ETC), PER OZ |
| A4371 |
OSTOMY SKIN BARRIER, POWDER, PER OZ |
| A4372 |
OSTOMY SKIN BARRIER, SOLID 4X4 OR EQUIVALENT, STANDARD WEAR, WITH BUILT-IN
CONVEXITY, EACH |
| A4373 |
OSTOMY SKIN BARRIER, WITH FLANGE (SOLID, FLEXIBLE OR ACCORDIAN), WITH
BUILT-IN CONVEXITY, ANY SIZE, EACH |
| A4375 |
OSTOMY POUCH, DRAINABLE, WITH FACEPLATE ATTACHED, PLASTIC, EACH |
| A4376 |
OSTOMY POUCH, DRAINABLE, WITH FACEPLATE ATTACHED, RUBBER, EACH |
| A4377 |
OSTOMY POUCH, DRAINABLE, FOR USE ON FACEPLATE, PLASTIC, EACH |
| A4378 |
OSTOMY POUCH, DRAINABLE, FOR USE ON FACEPLATE, RUBBER, EACH |
| A4379 |
OSTOMY POUCH, URINARY, WITH FACEPLATE ATTACHED, PLASTIC, EACH |
| A4380 |
OSTOMY POUCH, URINARY, WITH FACEPLATE ATTACHED, RUBBER, EACH |
| A4381 |
OSTOMY POUCH, URINARY, FOR USE ON FACEPLATE, PLASTIC, EACH |
| A4382 |
OSTOMY POUCH, URINARY, FOR USE ON FACEPLATE, HEAVY PLASTIC, EACH |
| A4383 |
OSTOMY POUCH, URINARY, FOR USE ON FACEPLATE, RUBBER, EACH |
| A4384 |
OSTOMY FACEPLATE EQUIVALENT, SILICONE RING, EACH |
| A4385 |
OSTOMY SKIN BARRIER, SOLID 4X4 OR EQUIVALENT, EXTENDED WEAR, WITHOUT
BUILT-IN CONVEXITY, EACH |
| A4387 |
OSTOMY POUCH, CLOSED, WITH BARRIER ATTACHED, WITH BUILT-IN CONVEXITY (1
PIECE), EACH |
| A4388 |
OSTOMY POUCH, DRAINABLE, WITH EXTENDED WEAR BARRIER ATTACHED, (1 PIECE),
EACH |
| A4389 |
OSTOMY POUCH, DRAINABLE, WITH BARRIER ATTACHED, WITH BUILT-IN CONVEXITY (1
PIECE), EACH |
| A4390 |
OSTOMY POUCH, DRAINABLE, WITH EXTENDED WEAR BARRIER ATTACHED, WITH BUILT-IN
CONVEXITY (1 PIECE), EACH |
| A4391 |
OSTOMY POUCH, URINARY, WITH EXTENDED WEAR BARRIER ATTACHED (1 PIECE),
EACH |
| A4392 |
OSTOMY POUCH, URINARY, WITH STANDARD WEAR BARRIER ATTACHED, WITH BUILT-IN
CONVEXITY (1 PIECE), EACH |
| A4393 |
OSTOMY POUCH, URINARY, WITH EXTENDED WEAR BARRIER ATTACHED, WITH BUILT-IN
CONVEXITY (1 PIECE), EACH |
| A4394 |
OSTOMY DEODORANT, WITH OR WITHOUT LUBRICANT, FOR USE IN OSTOMY POUCH, PER
FLUID OUNCE |
| A4395 |
OSTOMY DEODORANT FOR USE IN OSTOMY POUCH, SOLID, PER TABLET |
| A4396 |
OSTOMY BELT WITH PERISTOMAL HERNIA SUPPORT |
| A4397 |
IRRIGATION SUPPLY; SLEEVE, EACH |
| A4398 |
OSTOMY IRRIGATION SUPPLY; BAG, EACH |
| A4399 |
OSTOMY IRRIGATION SUPPLY; CONE/CATHETER, WITH OR WITHOUT BRUSH |
| A4402 |
LUBRICANT, PER OUNCE |
| A4404 |
OSTOMY RING, EACH |
| A4405 |
OSTOMY SKIN BARRIER, NON-PECTIN BASED, PASTE, PER OUNCE |
| A4406 |
OSTOMY SKIN BARRIER, PECTIN-BASED, PASTE, PER OUNCE |
| A4407 |
OSTOMY SKIN BARRIER, WITH FLANGE (SOLID, FLEXIBLE, OR ACCORDION), EXTENDED
WEAR, WITH BUILT-IN CONVEXITY, 4 X 4 INCHES OR SMALLER, EACH |
| A4408 |
OSTOMY SKIN BARRIER, WTIH FLANGE (SOLID, FLEXIBLE OR ACCORDION), EXTENDED
WEAR, WITH BUILT-IN CONVEXITY, LARGER THAN 4 X 4 INCHES, EACH |
| A4409 |
OSTOMY SKIN BARRIER, WITH FLANGE (SOLID, FLEXIBLE OR ACCORDION), EXTENDED
WEAR, WITHOUT BUILT-IN CONVEXITY, 4 X 4 INCHES OR SMALLER, EACH |
| A4410 |
OSTOMY SKIN BARRIER, WITH FLANGE (SOLID, FLEXIBLE OR ACCORDION), EXTENDED
WEAR, WITHOUT BUILT-IN CONVEXITY, LARGER THAN 4 X 4 INCHES, EACH |
| A4411 |
OSTOMY SKIN BARRIER, SOLID 4X4 OR EQUIVALENT, EXTENDED WEAR, WITH BUILT-IN
CONVEXITY, EACH |
| A4412 |
OSTOMY POUCH, DRAINABLE, HIGH OUTPUT, FOR USE ON A BARRIER WITH FLANGE (2
PIECE SYSTEM), WITHOUT FILTER, EACH |
| A4413 |
OSTOMY POUCH, DRAINABLE, HIGH OUTPUT, FOR USE ON A BARRIER WITH FLANGE (2
PIECE SYSTEM), WITH FILTER, EACH |
| A4414 |
OSTOMY SKIN BARRIER, WITH FLANGE (SOLID, FLEXIBLE OR ACCORDION), WITHOUT
BUILT-IN CONVEXITY, 4 X 4 INCHES OR SMALLER, EACH |
| A4415 |
OSTOMY SKIN BARRIER, WITH FLANGE (SOLID, FLEXIBLE OR ACCORDION), WITHOUT
BUILT-IN CONVEXITY, LARGER THAN 4X4 INCHES, EACH |
| A4416 |
OSTOMY POUCH, CLOSED, WITH BARRIER ATTACHED, WITH FILTER (1 PIECE),
EACH |
| A4417 |
OSTOMY POUCH, CLOSED, WITH BARRIER ATTACHED, WITH BUILT-IN CONVEXITY, WITH
FILTER (1 PIECE), EACH |
| A4418 |
OSTOMY POUCH, CLOSED; WITHOUT BARRIER ATTACHED, WITH FILTER (1 PIECE),
EACH |
| A4419 |
OSTOMY POUCH, CLOSED; FOR USE ON BARRIER WITH NON-LOCKING FLANGE, WITH
FILTER (2 PIECE), EACH |
| A4420 |
OSTOMY POUCH, CLOSED; FOR USE ON BARRIER WITH LOCKING FLANGE (2 PIECE),
EACH |
| A4421 |
OSTOMY SUPPLY; MISCELLANEOUS |
| A4422 |
OSTOMY ABSORBENT MATERIAL (SHEET/PAD/CRYSTAL PACKET) FOR USE IN OSTOMY POUCH
TO THICKEN LIQUID STOMAL OUTPUT, EACH |
| A4423 |
OSTOMY POUCH, CLOSED; FOR USE ON BARRIER WITH LOCKING FLANGE, WITH FILTER (2
PIECE), EACH |
| A4424 |
OSTOMY POUCH, DRAINABLE, WITH BARRIER ATTACHED, WITH FILTER (1 PIECE),
EACH |
| A4425 |
OSTOMY POUCH, DRAINABLE; FOR USE ON BARRIER WITH NON-LOCKING FLANGE, WITH
FILTER (2 PIECE SYSTEM), EACH |
| A4426 |
OSTOMY POUCH, DRAINABLE; FOR USE ON BARRIER WITH LOCKING FLANGE (2 PIECE
SYSTEM), EACH |
| A4427 |
OSTOMY POUCH, DRAINABLE; FOR USE ON BARRIER WITH LOCKING FLANGE, WITH FILTER
(2 PIECE SYSTEM), EACH |
| A4428 |
OSTOMY POUCH, URINARY, WITH EXTENDED WEAR BARRIER ATTACHED, WITH FAUCET-TYPE
TAP WITH VALVE (1 PIECE), EACH |
| A4429 |
OSTOMY POUCH, URINARY, WITH BARRIER ATTACHED, WITH BUILT-IN CONVEXITY, WITH
FAUCET-TYPE TAP WITH VALVE (1 PIECE), EACH |
| A4430 |
OSTOMY POUCH, URINARY, WITH EXTENDED WEAR BARRIER ATTACHED, WITH BUILT-IN
CONVEXITY, WITH FAUCET-TYPE TAP WITH VALVE (1 PIECE), EACH |
| A4431 |
OSTOMY POUCH, URINARY; WITH BARRIER ATTACHED, WITH FAUCET-TYPE TAP WITH
VALVE (1 PIECE), EACH |
| A4432 |
OSTOMY POUCH, URINARY; FOR USE ON BARRIER WITH NON-LOCKING FLANGE, WITH
FAUCET-TYPE TAP WITH VALVE (2 PIECE), EACH |
| A4433 |
OSTOMY POUCH, URINARY; FOR USE ON BARRIER WITH LOCKING FLANGE (2 PIECE),
EACH |
| A4434 |
OSTOMY POUCH, URINARY; FOR USE ON BARRIER WITH LOCKING FLANGE, WITH
FAUCET-TYPE TAP WITH VALVE (2 PIECE), EACH |
| A4450 |
TAPE, NON-WATERPROOF, PER 18 SQUARE INCHES |
| A4452 |
TAPE, WATERPROOF, PER 18 SQUARE INCHES |
| A4455 |
ADHESIVE REMOVER OR SOLVENT (FOR TAPE, CEMENT OR OTHER ADHESIVE), PER
OUNCE |
| A4456 |
ADHESIVE REMOVER, WIPES, ANY TYPE, EACH |
| A5051 |
OSTOMY POUCH, CLOSED; WITH BARRIER ATTACHED (1 PIECE), EACH |
| A5052 |
OSTOMY POUCH, CLOSED; WITHOUT BARRIER ATTACHED (1 PIECE), EACH |
| A5053 |
OSTOMY POUCH, CLOSED; FOR USE ON FACEPLATE, EACH |
| A5054 |
OSTOMY POUCH, CLOSED; FOR USE ON BARRIER WITH FLANGE (2 PIECE),
EACH |
| A5055 |
STOMA CAP |
| A5056 |
OSTOMY POUCH, DRAINABLE, WITH EXTENDED WEAR BARRIER ATTACHED, WITH FILTER,
(1 PIECE), EACH |
| A5057 |
OSTOMY POUCH, DRAINABLE, WITH EXTENDED WEAR BARRIER ATTACHED, WITH BUILT IN
CONVEXITY, WITH FILTER, (1 PIECE), EACH |
| A5061 |
OSTOMY POUCH, DRAINABLE; WITH BARRIER ATTACHED, (1 PIECE), EACH |
| A5062 |
OSTOMY POUCH, DRAINABLE; WITHOUT BARRIER ATTACHED (1 PIECE), EACH |
| A5063 |
OSTOMY POUCH, DRAINABLE; FOR USE ON BARRIER WITH FLANGE (2 PIECE SYSTEM),
EACH |
| A5071 |
OSTOMY POUCH, URINARY; WITH BARRIER ATTACHED (1 PIECE), EACH |
| A5072 |
OSTOMY POUCH, URINARY; WITHOUT BARRIER ATTACHED (1 PIECE), EACH |
| A5073 |
OSTOMY POUCH, URINARY; FOR USE ON BARRIER WITH FLANGE (2 PIECE),
EACH |
| A5081 |
CONTINENT DEVICE; PLUG FOR CONTINENT STOMA |
| A5082 |
CONTINENT DEVICE; CATHETER FOR CONTINENT STOMA |
| A5083 |
CONTINENT DEVICE, STOMA ABSORPTIVE COVER FOR CONTINENT STOMA |
| A5093 |
OSTOMY ACCESSORY; CONVEX INSERT |
| A5102 |
BEDSIDE DRAINAGE BOTTLE WITH OR WITHOUT TUBING, RIGID OR EXPANDABLE,
EACH |
| A5120 |
SKIN BARRIER, WIPES OR SWABS, EACH |
| A5121 |
SKIN BARRIER; SOLID, 6 X 6 OR EQUIVALENT, EACH |
| A5122 |
SKIN BARRIER; SOLID, 8 X 8 OR EQUIVALENT, EACH |
| A5126 |
ADHESIVE OR NON-ADHESIVE; DISK OR FOAM PAD |
| A5131 |
APPLIANCE CLEANER, INCONTINENCE AND OSTOMY APPLIANCES, PER 16 OZ. |
| A6216 |
GAUZE, NON-IMPREGNATED, NON-STERILE, PAD SIZE 16 SQ. IN. OR LESS, WITHOUT
ADHESIVE BORDER, EACH DRESSING |
| A9270 |
NON-COVERED ITEM OR SERVICE |
