Product Manual

Hollister Incorporated 1.888.740.8999
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Medicare Utilization Chart
A5081 Continent device, plug for continent stoma 31 ea/mo
A5082 Continent device, catheter for continent stoma 1 ea/mo
A5083 Continent device, stoma absorptive cover for continent stoma 150 ea/mo
A5093 Ostomy accessory, convex insert 10 ea/mo
A5102 Bedside drainage bottle with or without tubing, rigid or 2 ea/6 mo
expandable, each
A5120 Skin barrier, wipes or swabs, each 150 ea/6 mo
A5121 Skin barrier, solid, 6 x 6 or equivalent, each 20 ea/mo
A5122 Skin barrier, solid, 8 x 8 or equivalent, each 20 ea/mo
A5126 Adhesive or non-adhesive, disk or foam pad 20 ea/mo
A5131 Appliance cleaner, incontinence and ostomy 1 ea (16 oz btl)/mo
appliances, per 16 ounce
A6216 Gauze, non-impregnated, non sterile, pad size 16 sq in 60 ea/mo
or less, without adhesive border, each dressing
A9270 Non-covered item or service
✳
HCPCS Long Description Quantity
✳
No established usual maximum, refer to Medicare Utilization Guidelines.
How to Size Hollister Ostomy Pouches
A properly tted pouch is essential to minimize stomal and
skin irritation and to obtain optimum pouch wear time. A
stoma measuring guide allows correct measurement of the
stoma. Measure the stoma accurately. Select the smallest
barrier opening which ts comfortably around the stoma
without actually touching it. Too large an opening will leave
skin exposed and could lead to skin irritation or erosion.
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