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Procedure code
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Procedure code
description
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Maximum allowed units
|
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A4407
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Ext wear ost sknbarr <=4SQ"
|
2 units per week/104 units per year
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A4409
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Ost skin barr convex <=4 SQ I
|
2 units per week/104 units per year
|
|
A4408
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Ext wear ost skn barr >4SQ"
|
2 units per week/104 units per year
|
|
A4410
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Ost skn barr extnd >4 SQ
|
2 units per week/104 units per year
|
|
A5056
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1 pc ost pouch w filter
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2 units per week/104 units per year
|
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A5057
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1 pc ost pou w built-in conv
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2 units per week/104 units per year
|
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A4425
|
Ost pch drain for barrier fl
|
2 units per week/104 units per year
|
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A4391
|
Urinary pouch w ex wear barr
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2 units per week/104 units per year
|
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A4393
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Urine pch w ex wear bar conv
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2 units per week/104 units per year
|
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A4428
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Urine ost pouch w faucet/tap
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2 units per week/104 units per year
|
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A4430
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Ost urine pch w b/bltin conv
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2 units per week/104 units per year
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A4416
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Ost pch clsd w barrier/filtr
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3 units per week/156 units per year
|
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A4419
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Ost pch for bar w flange.flt
|
3 units per week/156 units per year
|
|
A4406
|
Pectin based ostomy paste
|
3 units per week/156 units per year
|
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A4413
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2 pc drainable ost pouch
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2 units per week/104 units per year
|
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A4424
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Ost pch drain w bar & filter
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2 units per week/104 units per year
|
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A4432
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OS pch urine w bar/fange/tap
|
2 units per week/104 units per year
|
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A4435
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1pc ost pch drain hgh output
|
2 units per week/104 units per year
|
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A5073
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Urinary pouch on barr w/flng
|
2 units per week/104 units per year
|
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A4371
|
Skin barrier powder per oz
|
2 units per year
|
|
A4396
|
Peristomal hernia support blt
|
2 units per year
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