Product Manual

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www.hollister.com Hollister Incorporated
A4423 Ostomy pouch, closed, for use on barrier with locking 60 ea/mo
ange, with lter (2 piece), each
A4424 Ostomy pouch, drainable, with barrier attached, with lter 20 ea/mo
(1 piece), each
A4425 Ostomy pouch, drainable, for use on barrier with 20 ea/mo
non-locking ange, with lter (2 piece system), each
A4426 Ostomy pouch, drainable, for use on barrier with 20 ea/mo
locking ange (2 piece system), each
A4427 Ostomy pouch, drainable, for use on barrier with 20 ea/mo
locking ange, with lter (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 20 ea/mo
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 20 ea/mo
faucet-type tap, with valve (1 piece), each
A4432 Ostomy pouch, urinary, for use on barrier with 20 ea/mo
non-locking ange, with faucet-type tap with valve
(2 piece), each
A4433 Ostomy pouch, urinary, for use on barrier with 20 ea/mo
locking ange (2 piece), each
A4434 Ostomy pouch, urinary, for use on barrier with 20 ea/mo
locking ange, with faucet-type tap with valve
(2 piece), each
A4450 Tape, non-waterproof, per 18 square inches 40 ea (18 sq in)/mo
A4452 Tape, waterproof, per 18 square inches 40 ea (18 sq in)/mo
A4455 Adhesive remover or solvent (for tape, cement, or other 16 oz/6 mo
adhesive), per ounce
A4456 Adhesive remover, wipes, any type, each
✳
A5051 Ostomy pouch, closed, with barrier attached 60 ea/mo
(1 piece), each
A5052 Ostomy pouch, closed, without barrier attached, 60 ea/mo
(1 piece), each
A5053 Ostomy pouch, closed, for use on faceplate, each 60 ea/mo
A5054 Ostomy pouch, closed, for use on barrier with ange 60 ea/mo
(2 piece), each
A5055 Stoma Cap 31 ea/mo
A5056 Ostomy pouch, drainable, with extended wear barrier
✳
attached, with lter, (1 piece), each
A5057 Ostomy pouch, drainable, with extended wear barrier
✳
attached, with built-in convexity, with lter, (1 piece), each
A5061 Ostomy pouch, drainable, with barrier attached 20 ea/mo
(1 piece), each
A5062 Ostomy pouch, drainable, without barrier attached 20 ea/mo
(1 piece), each
A5063 Ostomy pouch, drainable, for use on barrier with ange 20 ea/mo
(2 piece system), each
A5071 Ostomy pouch, urinary, with barrier attached 20 ea/mo
(1 piece), each
A5072 Ostomy pouch, urinary, without barrier attached 20 ea/mo
(1 piece), each
A5073 Ostomy pouch, urinary, for use on barrier with ange 20 ea/mo
(2 piece), each
HCPCS Long Description Quantity
✳
No established usual maximum, refer to Medicare Utilization Guidelines.